Expansion Through Contraction

It’s a dilemma that all firms face: grow at any cost and lose sight of your purpose, or be more selective, but risk being more vulnerable. We face it as individuals as well. Do we specialize in a certain aspect of practice (design or construction management) or a project type (education or healthcare) or do we try and have a full complement of experience and skills? Either way, we are limiting ourselves. Diversity can lead to dilution and distraction of our creative spirit, while specialization and focus can cultivate expertise, but narrow our options.
So which to choose?  Both and neither.  It all depends.  On you.  Only you know what combination of skills allow you to be your best creative self and continue to grow and add value as an architect.  Only when you and those who work for you are growing and inspired by the work you do willl you see a profound change in your business.  I’ve been reading a lot lately about a prevailing wisdom in the social media world to have fewer but more relevant and loyal followers. The point: It’s not a popularity contest and you don’t gain much by following/friending/connecting with anything that moves. Social media only works if it’s opening up a conduit between you and people who either provide you with information of value or who will value the information you produce. I think that this is a good way to look at our practice of architecture as well. Unless the only point for you is making money, you want to know that the work you did made a difference. You might want to feel that people’s lives were improved by your design. The inverse of this is also true, you want to have a client base that values creativity and innovation and will seek out your talents rather than one that views you as a commodity and just wants the lowest fee.

The key is selectivity. You don’t necessarily have to specialize, but you do need to clearly define what you do and then do it exceptionally well. This may mean turning down work, or leaving a firm if you feel that your ability to learn, grow and be excellent at the things you most value about being an architect are compromised. You can think I’m crazy, pull out a list of bills you have to pay and tell yourself that you have to suck it up. Or you can be really brave and follow your passion. Which option do you think will take you where you really want to go? Clients respond to your passion. They seek out consultants who they feel have an approach to design compatible with their goals for not just the end result but the process of design.

We want so badly to be seen as both hero and artist, some mythical construct (pun intended) of what an architect is, or rather could be. This seemingly principled stance actually puts us in the predicament of undervaluing our servicess in favor of what we believe to be the opportunity.  This anything to get a job, that job, mentality is bad business.  As this recent piece by Mike Michalowicz for the Wall Street Journal  shows, you really do get a positive response when you choose to value yourself and stop being hesitant about the services you have to offer. It's clarity of purpose that leads you down your chosen career path, not playing the game by someone else's rules.

I had an opportunity to do this early on in my career.  Graduating in the midst of the last recession meant jobs were scare for entry level architects and I ended up going to graduate school.  Having completed by BARCH degree, I had no prerequisites and could spend the year getting my Master's degree pursuing any aspect of architecture that interested me.  I drew on what I loved most about my undergraduate experience- sociocultural issues.  That gave me a lot of clarity about why I am an architect, but initially pointed me down a road of urban planning.  However, life shifts and somehow I ended up doing healthcare.  I had to stop and reassess how or even whether this type of work fit with my architectural identity.  It did, but then I found that my identity as a healthcare architect did not fit with the approach to healthcare design of the firm that employed me. One of the greatest gifts I received in the past year was being laid off from said soul-killing job. Sure I knew I needed to leave. I was even looking for other opportunities. But I wanted to play it safe and stay until I found that perfect next move. Being laid off gave me time and space to think about what I wanted to do and how I hoped to accomplish that.  This blog is the perfect example. I got the idea about a year ago and finally managed to get started in May of 2010. My initial few middling posts were made in between everything else that was going on and I didn’t really promote them because they weren’t at the level that I wanted them to be. Being laid off allowed me to really research how to write effective posts and how to promote them. It also allowed me a chance to discover a whole data stream available to me just by adjusting some filters on my twitter account. My blog has gotten me a speaking engagement as well as helped me get the consulting job I have today. It is my vehicle to promote who I am and what I believe about being an architect. Having gotten to that point of clarity, my brand if you will, I can market myself for the things I am both expert in and passionate about. You can agree with me or not, but you know where I stand. It’s out there in front of me and not up for debate. What about you? When was the last time you took your career’s temperature? Are you distracted by trying to do a little bit of everything competently or are you focusing on doing the things you love really, really well for clients that will appreciate them?

Home Sweet (Medical) Home

As culture shifts so, does the space that contains the activities pursued by that culture.  Health and wellness have become so intertwined with our everyday lives that we are quick to self-prescribe activities like yoga or spa visits, join a gym or adopt a fitness regimen, consult a nutritionist or seek out alternative therapies like acupuncture.  We still view our healthcare system, however as something that we need only when we are sick.  That’s all changing.

In case you haven’t noticed, the emphasis on wellness has been adopted by your local hospital, clinic and physician.  If they haven’t they may find themselves in a change or perish position.  Healthcare reform is a loaded issue and what if any of it actually gets implemented is still in question.  What is not in question is the cultural shift in care brought about by the wellness movement.  It creates whole new archetypes for us; spaces that are permutations, hybrids and creations of a new set of functions and needs.  As architects we need to be first responders and help usher in this new breed of spaces.  Some trends of the wellness movement that will impact the built environment are as follows:

It’s all about integration.  Expect to see functions like education and community gathering spaces as well as gyms or outdoor exercise areas built into medical office or hospital facilities.  Some will even feature spa and cosmeceutical services as part of an expanded dermatology practice.  On the flip side, you may start to see unlikely clients dipping a toe in the healthcare water- like big box retailers, grocery stores, and spas or fitness centers.

There will be distillation points.  While the range of services and activities may expand at a given healthcare location, expect to see the emergence of an almost concierge-like approach to care management.  The medical home is a new model that seeks to integrate primary care with specialty care, social services and alternative therapies in a single location with a single coordinator.  This helps patients to receive a more holistic treatment for their diseases or disorders and streamlines their ability to access a broader range of services.

Patients have become consumers.  We have been hearing about this trend for a while now, but as it gains momentum, a more retail-based business model will emerge, and this will affect how space is programmed and designed. Finishes and lighting will take on a level of importance previously unknown in healthcare.   Every detail from customer service to appearance and philosophy of care will be factored into their decision of one care provider over another.  See a great example of this in Domokur Architect’s execution of Dr. Darrell White’s concept for Skyvision, patterned after upscale retail environments. Also note that the brand extends beyond the building to Dr. White’s comprehensive approach to care and social media/internet presence. 

A distinct shift to outpatient care. Expect more and more services that were traditionally considered inpatient to become less invasive and performed on an outpatient basis.  This will require more specialized procedure rooms in outpatient facilities.  We’ll also start to see traditionally hospital based-specialists needing to do more than a quick consult with a patient- they now will perform many of their procedures in that same office.

So what’s the emerging archetype?
1. More multi-use and multi-purpose spaces.  Healthcare will be about delivering comprehensive wellness strategies as a part of a continuum of care as opposed to treating only a particular disease when the patient presents.  It also will be team-based instead of physician based and a broader range of clinicians and social workers may be involved in the patient’s care plan.  Therefore, there will be a need to engage patients more fully in managing their own care.  A different range of environments for meeting and working with patients will be necessary.  You may find yourself really thinking about site design and amenities, or providing child-care or library space.  These spaces may also flex to become community rooms or group education rooms.  There may be fewer exam rooms, but more procedure and consult rooms.  There is also a need to create collaboration spaces where the entire care team can meet to review a patient’s status on a regular basis and determine how to address needs as they arise.

2. Image and accessibility matter. To compete for the consumer-oriented patient, facilities will have to be more accessible.  Not only will physical appeal be important, but good marketing efforts will be necessary.  As architects, we may find ourselves much more closely aligned with graphic designers and public relations professionals to produce a seamless corporate image that reflects a well defined philosophy of care.

3. A rethinking of what a visit entails.  Patients are going to expect to see a more involved discussion of their overall health record at each visit.  The design of the typical exam room will change. While most do include a charting area, it is usually quite small and does not enable the patient and doctor to sit side by side to review either on-screen or printed information.  Many patients do not even use an exam table for most doctor visits, so it might be beneficial to have consult rooms vs. exam rooms.  The consult room could have some of the same elements as a typical exam room like blood pressure cuff, oto/opthamoscope, hand washing sink and supply/work counter.  However, instead of an exam table, the room might feature a table and chairs- allowing the doctor to do a routine check of vitals, then spend the majority of the time reviewing the results of the exam within the context of the patient’s health history and health trends.  Especially for those with chronic conditions like high blood pressure or diabetes who visit the doctor on a monthly basis, this type of room would be far more comfortable and conducive to their needs.  It would enable the patient, physician and any accompanying family member to share the events of the visit within the context of a health profile. A table would also allow both doctor and patient to bring along their own supplemental materials to share or record the events of the visit.

4. More virtual access to care and medical records to allow real-time monitoring of patients’ progress.  This is not a new concept, but I am always amazed at how seldom anyone talks about HOW this monitoring will take place.  We may need to have more of a cybercafe for medical staff where they can take time to sit and do a download on a batch of patients, process the information and send back responses to them.  If a dialogue is encouraged, physician assistants need to have computer workstations where they can do a daily monitoring of patient results and respond to any emails or requests for information from patients.  It’s a much more hands-on and higher level of care than most doctors offices are used to delivering, but I see this as a trend that would also affect the physical space of an office in order to provide a private and secure location to view and respond to patient information.  Perhaps that interactive conference room space mentioned earlier might double as the data sharing area.

As you can see, the paradigm of the doctor’s office is rapidly being converted into a different type of health destination, one that supports more comprehensive, longitudinal and interactive care.  Share your experiences with recent medical offices and let me know if you are dealing with any or all of these issues.

Post-post update:  So many great thoughts were put out there on the Linked in shared version of this post that I am including them directly one the blog as comments as well.  Please feel free to add your thoughts to the mix.

Crowdsourcing for Thoughtleaders

We have all experienced the “big city, little town” effect. My phrase for the inner circles that develop where certain experts in any given issue become identified and therefore the go-to people for anything and everything related to that issue (even areas that are tangential at best to their actual expertise). They end up overcommitted while other voices never get the opportunity to participate. As someone who has been on both ends of this effect at various points in my career, I marvel at the way a relatively small group of people or companies can have an outsized influence on issues. They have become thought leaders. In the traditional world, thought leaders get sought out for speaking engagements, committee assignments, appointed positions in the community. They are featured in articles and honored at awards ceremonies. Companies spend whole retreats deciding how to become thought leaders in various market sectors. We all want to be thought leaders when we grow up. Now we can.

While thought leader is certainly high on my list of favorite buzzwords rapidly awaiting cliché status, I am even more enamored of the idea of crowdsourcing. Crowdsourcing is a wannabe thought leader’s dream, an actual thought leader’s chance to break new ground, and anyone else with a passion for an issue to get their two cents in. Crowdsourcing is the process of posing a question or problem openly and allowing responses from anyone and everyone. The best answer wins. In the digitally connected world, this is a nearly effortless process on the part of the “sourcer.” It’s almost stupid not to crowdsource, even if you also pursue more traditional ways of procuring work or developing a product.

This may sound roughly equivalent to what we as architects call the design competition. But crowdsourcing extends beyond the typical call for entries. As a much more loosely defined problem with much less rigid response format, it’s really all about the idea. More about collaboration than competition, respondents can see and comment on each other’s answers, building and evolving the idea. Also, because of the much more open platform, the generator of the request can also gauge what types of responses are most relevant to the audience they are trying to reach with the desired end product. This approach encourages blue sky thinking and true innovation and is beginning to influence the way that companies approach problems.

A great example of this is Kaiser Permanente’s interesting hybrid of the design competition based on the idea of crowdsourcing. While not interactive like typical crowdsourcing, it still employs a much more accessible platform and broader scope of awareness to encourage more response. Anyone can enter their Small Hospital, Big Idea challenge and they stress a much more comprehensive and interdisciplinary approach than just design: “We are appealing to the world's most talented minds to help design a revolutionary small hospital that can overcome the unique challenges of a small market (e.g., scarce resources and a shrinking pool of skilled clinical staff) and deliver exceptional, effective, and convenient care to our members. The hospital should have a near-zero impact on the environment.” Wow. That’s a lot to put out there, but with a crowdsourced approach, they just might get it.

Crowdsourcing allows a greater and much more diverse pool of thought leaders to emerge and eliminates the myopic approach of overburdening a few with the tasks of the many. It ushers in fresh thinking and challenges expectations. It open sources our access to expertise to form strategic partnerships. This is one buzzword that might just change the design industry. How will you use it to become a thought leader?

Pre-Fab is Ab-Fab

I remember playing with Legos as a kid. The bricks were modular and contained prefabricated specialty elements, yet I never felt that my creativity was threatened by these constraints. Why is it then that as grown-up architects we bristle at the idea of modular and prefabricated construction? We think “trailer park” and wide load trucks on the freeway. We think that all design has been taken to the lowest common denominator. In reality, the prefabricated industry has evolved into a highly sophisticated range of projects. While you can buy the cringe-inducing whole house, you can also buy pre-engineered systems that are your kit of parts to make amazing buildings. Prefabricated elements can also be a more planet-friendly solution.

One of my favorite sustainability sites, Inhabitat, had a recent article on a prefabricated house built in Seattle by Greenfab and designed and assembled by HyBrid Architecture. The model home is working towards LEED Platinum and qualifies as restorative with it’s net zero footprint and ability to generate its own power. While Greenfab makes a kit of modular parts, they also can work with clients to create custom design or just to reassemble their offerings in new ways. There is also a great article in ED+C magazine by Dru Meadows that details how by reducing waste on the front end, prefabricated construction can outperform other downstream efforts using the more traditional reduce, reuse recycle method. It’s a dramatic difference. Enough to make all of use reconsider prefabricated and modular construction as a matter of conscience.
Prefabricated elements have better quality control and produce less construction waste. They also allow a higher degree of integrated elements like smart technology, LED systems or materials that contribute to the design or flexibility of a component. I myself have always dreamed of a “walls on wheels” concept that truly allowed one to adjust the spaces to your individual needs. The one thing we know about the spaces in our world is that they need to support ongoing change of needs and function. Another plus of prefab: pieces and parts can be adaptively re-used to suite the needs of the occupants over time and easily dismantled and recycled at the end of the house’s life. Because they can be delivered to the site 80% installed, the actual construction time on site is greatly reduced.

So what changes? As a designer, you should develop a relationship with either a pre-fab constructor or manufacturers of pre-fab elements so that you can collaborate with them. I have also pulled together some advice to help you channel the modular mindset (you can also visit the Modular Building Institute to learn more):

1. Know your team. The fewer players, the fewer points of accountability, which is always a good thing. Many modular construction companies will also provide the option of constructing smaller commercial or residential structures as part of their package, which further enhances the design-build relationship.

2. Understand the kit of parts, what is considered partially custom and fully custom. Don’t be afraid to bring your imagination along. Because the modules are factory built, you can develop prototypes to get the design to work perfectly.

3. Design mindful of how each element can be a variation on a theme. The more repeatable modules you can use, the greater the efficiency of construction and lower the cost. This can be an especially effective strategy for large buildings like hospitals that contain many repeated elements like headwalls that are found in some form across many different departments.

 4. Think more about how the building will be used and how each element will support that use. A module doesn’t have to be as dumb as: wall, 10 foot high stud with drywall. Instead it can be: wall 10 foot high with built-in light source and touch activated media.

Far from being a limit on your design sensibilities, prefabricated and modular elements can actually set your imagination free and allow you to do things that would not be possible or feasible with traditional construction methods. Please share your thoughts and experiences with modular construction. I'm interested to hear the good, bad and ugly as well as how you got over any negative stereotypes about this construction method.