Alchemy and Architecture: How rich is your perspective?

What’s your point of view? How is it the same as or different from that of the users who will inhabit your design? How is it perhaps still different from that of your client?

In quite a few recent posts, I’ve discussed the idea that architects need to provide a value beyond just our traditional scope of services in order to stay relevant. This value often comes with the ability to harness and master data from its collection to application on the project. However, as we go boldly forward with integrated project delivery, evidence based design and quantifications of value associated with sustainability (green) and productivity (lean), it is all too easy to feel that creativity must emerge in spite of - not because of - these constraints. No, you are not off the hook in terms of shifting your practice model to incorporate the aforementioned value streams. You are being challenged to be more than an information generator and processor (overwhelming and boring). Too much of our time and energy is wasted feeling besieged yet unchallenged and uninspired.

The value of the architect in today’s world lies in his or her ability to synthesize. An excellent series of articles by Jon Kolko for Fast Company based on his book, Exposing the Magic of Design, caught my attention because they address precisely what makes us creative, as well as how we can allow our creativity to get lost in translation by being overly concerned about process and data. Kolko uses the term “sensemaking,” which has its roots in behavioral psychology, even going so far as to term the act of design as applying bias. We’re conditioned to view it as a four-letter word, but it’s impossible for anyone not to process the world through their individual filters. Bias represents the personal perspective of the individual designer, and the more interesting their perspective, the more likely they are to bring an exciting design solution to the table. Neutralizing your bias is the equivalent of dumbing down your work. Allow yourself to value the explorer inside of you, to question the status quo and to feel that pushing the envelope is not just OK but necessary.

Being creative begins with being inspired. Being inspired comes from allowing yourself to ask what if? That’s a scary concept, and when we don’t know where to begin, we start following all the rules of design and allow constraints to eliminate creativity by a depressing process of attrition. We fail to approach the subject with fresh eyes, disgruntled that we are doing “another” (fill in blank) and have clients that only care about getting the most amount of building for the least amount of cost. How could anything innovative ever hope to arise out of this attitude?

While budget is certainly a serious concern on every project, our clients want to build the best buildings they can, not the cheapest or most adequate. They want a solution that works for them and supports the activities that need to take place. They understand the difference between cost and value, but they will also uphold cost as a determinant when design seems too wayward and devoid of value. They are relying on your vision to take a quagmire of facts, needs, data and requirements and start to connect the dots to form a solution. That is the alchemy of architecture, to transform a bunch of information into a design strategy that supports an underlying project mission. To apply your vision and design the spaces that make people better.

Those voices you hear are the angels in the architecture, and you have to let them sing.

Green Fades to Blue: Would you rather sustain or be restored?

Mention restoration and most minds go to some historical building project. I subscribe to a much broader definition that encompasses the ability of a building to generate a positive effect. Beyond green design, which at best seeks neutrality, and at worst comes with practically a whole religion’s worth of moral baggage, restorative design, including “blue” principles, seeks to replenish us in body, mind and spirit. William McDonough has written about the power of architecture to be restorative and at the 2008 Sustainable Brands International Conference, Bob Isherwood introduced the term Blue design, to reflect the need for strategic and innovative solutions that give something back. In other words, it’s not enough to have the cache of being sustainable. To really impact people’s lives, we have to show them what’s in it for them- we need to provide restoration.
Think about the buildings in which we live, work and play: How do these environments contribute to the stress in our lives? How do they cost us too much money to maintain while giving us largely inadequate shelter and support to live our lives? How often might they actually be harmful to our well being through contaminants in the air or water, noise or light pollution? 

Blue as an expansive approach
Many early adopters of the term Blue Design or the phrase “green to blue” focus on the power of design to give something back to the community by having a net positive effect on air quality and energy (in the meantime, we have been hard pressed to even design net-zero, or energy neutral buildings). This narrow definition of blue loses sight of a much larger goal that we should be striving for in our built environment, the ability to be restorative, even therapeutic. While contaminants in that environment can contribute to a lack of focus and well being, cultural impacts are far greater. We inhabit a world of sensory overload. We lead isolated and independent lives in the processed, overproduced stage set of life. Depleting days feature streaming information in the form of constant interruptions and demands on our attention. The resulting level of stress that we experience impacts our ability to focus our attention, creating a state of persistent mental fatigue that impairs our quality of life. The antidote: a restorative environment.

Building for the senses

It’s unlikely that life in the information age is going to change anytime soon, or that its cultural impacts are necessarily negative. They just feel that way because there is such disconnect between our lifestyles and the spaces in which we live. The industrial age city and post-industrial sprawl has created both interior and exterior spaces that exacerbate our state of depletion. Our built world needs an overhaul.
Architecture, landscape and urban design elements can recharge our direct attention capabilities and restore balance and wellness in our lives if our designs reconnect users with nature and other living things through biophilic design strategies. Work towards solutions that encourage interaction and that provide relief from unwanted or irrelevant stimuli. While specific design strategies will arise from specific design problems, you should approach every project with the goal of restoration in mind. Some characteristics of restorative environmental design as defined by Stephen Kellert in his book Linkages: Understanding and Designing Connections between the Natural and Human Built Environments include:
  1. Prospect- the vista
  2. Refuge- the safe place
  3. Water-actual water or design elements that provide glimmer, movement or symbolic images representing water
  4. Biodiversity- a rich palette of natural materials supplied through both interactive spaces (gardens, planters) and views.
  5. Sensory Variability- response to the changing times of day and seasons
  6. Biomimicry-natural materials, natural forms and structures
  7. Sense of playfulness-things that delight, surprise and amuse
  8. Enticement-complexity that encourages exploration
When was the last time a building brought you joy? What if every building could?

Treat[ED]: Shifting the Emergency Department Paradigm

I’ve designed quite a few Emergency Departments, from large to small and concepts from zoning, to universal rooms to interior nurse cores and observation units. I have even participated on a team developing standards for one of the nation’s most prominent health systems. While all of these efforts focused on the patient experience and the standard of care, what we have really been doing is rearranging deck chairs on the Titanic that is the ED. ED volumes keep increasing at a pace that no expansion strategy could ever really address. Patients are not getting better access to care, in spite of our efforts. I guess that’s what happens when you treat the symptoms instead of the problem.
I have had some recent exciting conversations with Dr. Todd Warden whose work on implementing aggressive processes to improve ED throughput is a game-changer.  An article detailing his work
explains how we have traditionally been using not only the wrong metrics to project volumes during programming, but also the wrong paradigm for processing patients. As architects, we love a good form follows function argument and Dr. Wardens’ insights into ED function create some very interesting implications for design that I share with you here:

The ED is not a hopeless case

“I think the ROI benefits of strong new ED processes tightly integrated with complentary design bodes well for future of ED. I am working with a revenue cycle company Besler, who is interested in the impact of ED improvements on increased revenue and decreased cost of operations.” To help us better understand how this works, Dr. Warden focuses on some specific patient statistics. “The moving parts are Left Without Being Treated (LWOTs), elimination of Diversions, and over time increased volume due to improved patient satisfaction.” These variables can be significant when you consider the following example for a typical ED that sees 50,000 patients per year. “LWOT’s, if at 5% for a 50K volume ED is $400-500 for every patient that walks out and about 10% of those patients would be admitted, representing a loss of anywhere from $1 to 1.5M.” There is also a tendency to over-focus on the external causes of ED overcrowding, including efficient interface with other departments and the ability to get patients who will be admitted out of the ED. Dr. Warden’s concept for managing ED throughput challenges traditional process in order to deliver a more efficient outcome from within the department. This might seem like a management or operational exercise, but it is actually supported by the built environment:
1. The patient shouldn’t own the bed
Dr. Warden’s approach begins with a challenge to the way we program space. His study of departments has indicated that the way we typically calculate a peak ED volume actually does not account for the amount of fluctuation between the highest and lowest daily volumes and therefore provides an underestimation of the number of patient spaces needed. Further, we typically understand one patient space to mean one patient bay or exam room. In fact, many patients who come to the ED do not require a stretcher or a private room or bay at all. Even those who do may not need to be in such a space for the entire length of their stay. “By adhering to the idea that the patient owns the bed, we create a lot of needless crowding and bottlenecks”, says Dr. Warden.
2. Integrating process with Design
Two areas that Dr. Warden focuses on are capturing the true measure of volume and efficiently moving that volume of patients through the department. Interestingly, building more rooms is usually not the answer he recommends. “I really see three levels of intervention. The first is completely process-driven. By getting the ED staff to work more efficiently, they can get patients in and out of the department quicker. The second level involves renovation to create a better space for handling patients who are not ready for discharge but do not require a bed. Sometimes, giving up a few ED rooms or a section of waiting are can create this space and allow more patients to be treated. The final intervention occurs at facilities that must add additional space in order to manage their volumes. In these cases, I actually recommend that they build a space called a Rapid Evaluation Unit or REU. More importantly the additional volume created with a high-performance method such as the REU allows the additional volume to be absorbed usually without needing additional staff so most falls to the bottom line. By applying these principles to design, the ED unit is about a third of the construction cost of a typical unit but provides double the annual capacity of the same number of traditional ED beds.”

Read more similar content in an article by Dr. Frank Zilm, FAIA and FACHA on New Directions for the ED