Measuring Distance with Time

Metrics are a funny thing.  There are all kinds of units out there to measure mass, volume, length, duration, ratios, rates.  And there are all kinds of ways of processing these numbers to make judgments about things like returns on investment, energy efficiency, job performance, throughputs; and determine things like status and rank.  Healthcare institutions live and die by numbers every day.

But what kind of metrics do we have for emotion?  For perception and understanding? As architects, we bridge the world of what is measurable and what is felt.  The spaces we create have to facilitate performance, and also provide the kind of intangible benefits that are linked to people feeling better about their surroundings, and therefore functioning better within them. We obsess about the design of space in three dimensions, but often forget there are other dimensions like time, light, sound and smell.  People move through space and experience it in the context of the time of day and seasons. They also experience space within the context of their own lives.  Someone who is mentally debilitated by disease may view a sound, odor or pattern as disturbing.  Someone who is harried and stressed out may become frustrated in an environment where they cannot immediately find their way to critical destinations.  Someone who is afraid can easily become overwhelmed by the scale of a building.  Someone who is physically compromised can be agitated by loud noises and glaring lights.

We navigate this world with our senses.  Our environments influence how we feel, then think and act.   As a first step, think about just one of these dimensional variables, that of time.  Use it to generate a whole different kind of metric- a metric of experience.  Is a corridor 10 minutes long?  What does it feel like to move through a space for that length of time?  What if you have a sore hip or are in a wheelchair or have a young child with you?  I hope that you will encounter many revelations as you move down that path.

Design and Our Emotions

I recently watched an episode of Hoarders: Buried Alive and was struck by the fact that the physical environment created by the hoarders was a reflection of their mental anguish.  It was not so much that these people felt the need to collect or save materials as the fact that they had no way to mentally process all this stuff and they just kind of abandoned it in piles.  The same quantity of stuff in files, display cases and storage boxes all cataloged would not seem nearly so pathological.  Why? Because if the stuff was organized, the person would have a psychological handle on what they actually owned.  They would have control over their environment and the things within it.  
When we feel in control of our environment, we feel in control of our lives. This of course led me to think about how we as architects can help people to have control over their environments and help them make sense of the rituals of their lives as well as their supplies and posessions. Our space and our place in the world, whether at home, at work or in the places we go for entertainment, goods, services or healing, needs to reinforce not just who we are but who we want to be.  Our surroundings can reflect our emotional state, but they can also do just the opposite and influence it.  We are consummate consumers, on the acquisition warpath seeking the next thing to bring quality of life to our lives.  It is not things but meaning we seek.  Maybe all we really need to acquire is a meaningful sense of place.

Are You a Brand or a Commodity?

It’s easy in this economy to adopt a “whatever it takes” approach to getting work. Believe it or not, this actually can cost you projects because clients are looking for a team who can meet their needs, not just undercut the competition. If you have been going after any RFP that moves and buying jobs, stop. Right now. You might think, “What if I don’t do these things, and my competition does, and I lose the work?” You should worry about what would happen if you do these things and you win it.

You will have just reduced your practice: expertise, resources, and professional judgment to a commodity. No one values a commodity. No one has “commodity loyalty.” Commodity work is demoralizing. It is all about spending the least amount of time to get the most marginally acceptable and cheapest design. It is antithetical to our whole purpose as architects and frankly, makes us obsolete. Do enough of this work and you have a portfolio that only lets you continue to downward spiral. If you aren’t contributing inspired, designed solutions, what purpose do you really serve?

The same goes for the firms that give away their services, producing good designs and being attentive to clients, but at a huge loss just for the privilege of doing the work. Their desperation makes them a doormat. If you really look at these projects, they are filled with unnecessary compromises and lack true integrity because the architect did not command the client’s respect. Post mortems on these projects often show a great deal of time (and un-billable hours) spent like a dog chasing its tail pursuing every little whim and without any real control of the process of design.

I am not advocating arrogance. Nor am I recommending an approach so high minded that you essentially offer your clients a take it or leave it ultimatum. I would suggest that you do some very honest soul-searching. What do you really want to achieve in your practice? Has this deep seated reason for being been communicated to your staff, consultants and clients? Do they believe in it too? This core belief is your brand. It is unwavering in good economic times and bad, project type to project type, project delivery method to project delivery method. Your brand should be the rationale behind every decision you make, large or small, internally and externally.  It is what makes a client excited to work with you and motivated to collaborate as a team to produce an inspired design solution.


Know your brand.
Don't take actions that compromise your brand out of desperation.
Believe in your brand. 
Be amazing.

How Was Your Stay?

First, a confession: I do not specialize in hotel design. I design, research and program healthcare projects. While hospitals have certainly tried in recent years to embrace the aesthetics of hotel design to create a more welcoming and less institutional environment, I think that the synergy between these two archetypes goes far deeper. More than imitation, this is a fusion spawned by recent trends in healthcare that creates an opportunity for both industries:

Trend 1: A hospital stay does not make you “all better”

Patients admitted to hospitals are sicker than ever before due in large part to the fact that so many procedures can be performed on an outpatient basis. You need to have had a significant illness, catastrophic accident or major surgery to qualify as an inpatient today. Simultaneously, hospitals have come under pressure from the Centers for Medicare and Medicaid services as well as insurance companies to shorten lengths of stay. Discharged inpatients therefore, may still be in a precarious state of health.

Trend 2: Both caregivers and patients are getting older.

The increase in the elderly population is also a factor in the ability of a discharged patient to function at a very high level upon discharge. All of this places added burden on the caregiver(s), who may themselves have compromised health.

Trend 3: Consumers are driving the healthcare marketplace.

Patients and their families are realizing that they have choices. They are demanding convenience, access, responsiveness and amenity from their healthcare providers. Many hospitals are beginning to provide concierge service to VIP patients. Additionally, families often want short term child care, reference libraries, and better food choices. 

Trend 4: A greater emphasis on wellness and prevention has emerged

Many healthcare systems are now offering alternative and complementary therapies such as massage, yoga and acupuncture. They are also expanding campus design to include things like on-site walking or fitness trails, and community education rooms within the facility.

Many major hospitals are served by nearby hotels, including some franchises directly owned by the healthcare institution and located on-campus, and I see an opportunity do more than provide accommodations for families during a hospital stay or a convention venue. As a building type, hotels are consumer oriented and focused on the total guest experience. Designers of hotel environments as well as their clients understand the value of positive distraction and captivating guests during their stay.

As healthcare clients shift their focus from purely functional spaces to ones that incorporate evidence-based design strategies, the connection between the environment and the health of patients and performance of staff is undeniable. Market trends have also necessitated a re-evaluation of traditional business models and rethinking of the spectrum of services provided. Healthcare design teams are working with owners to create spaces that are relaxing and comforting, perhaps even inspirational, instead of clinical. Collaboration with hotel designers could produce inspired hybrid architecture that also results in construction and operational savings for both due to the ability to share spaces and create operational efficiencies. Hotels already know how to offer excellent amenities that can seamlessly integrate with the goal of a healthcare institution such as wellness services and alternative therapies for both patients and families, in spas, gyms and grounds, venues for educational an community classes, and possibly even providing a transitional environment for discharged inpatients who may not be fully ready to return home. An inpatient room and a hotel room are not that dissimilar after all.

Contagious: The Role of Infection Control in Design

At first glance, this seems like a REALLY dry topic. The overly-technical kind you gloss over when reading a magazine or skip out on attending at a conference. But, before you give up on reading this post, consider: who wants to see their hard work in design ruined by the unsightly application of hand sanitizer dispensers, or the failure to really think about the visual clutter that hand washing sinks bring? 

Compliance with their infection control policies are no laughing matter. The Centers for Medicare and Medicaid will no longer pay for charges to treat patients for hospital acquired infections (HAI). Additionally, The Joint Commission, who accredits many hospitals and ambulatory care facilities, looks for compliance with infection control standards during their facility inspections. Can good infection control practice be supported through design decisions?
It can if you work with staff, including the infection control director and materials management folks instead of leaving decisions up to the facility to figure out post-construction. Employ evidence-based design strategies and don’t forget to follow-up post-occupancy to see how they are working:


1. Out of sight is out of mind- sinks that are not conveniently located in the main path of travel into and out of patient rooms, exam and procedure rooms or treatment/recovery bays are not likely to be utilized. Study the flow of staff in their existing space and talk about the steps they take before entering and leaving the patient zone. 

2. Create visual cues to help remind staff to use the sink- use floor patterns, ceiling treatments, lighting or contrasts in finishes to call attention to the sink area. Positioning the sink in the patient’s line of sight can also keep the patient aware that the proper measures are being followed by their caregiver.

3. Don’t forget about the accessories. At every sink, is a dispenser for paper towels, and soap, trash disposal and possible space for a sharps container or glove boxes. Place these to avoid creating visual clutter- but don’t get too clever. Over-designed custom casework that doesn’t consider the process of caregiving often goes unused. For example, cabinets for glove boxes are abandoned in favor of boxes placed right on the counter the first time someone needs gloves and can’t find them instantly. Also, materials management often negotiates contracts with paper towel or soap companies and the ugly plastic dispensers are often part of the deal. Work closely with the hospital to develop a policy for these items or you may find a soap dispenser on the wall right above the countertop mounted one you designed. Give it a couple of years, and there will be a different plastic dispenser made all the more resplendent by the holes in the wall left by the previous one’s removal. 

4. And then there’s waste disposal. Staff usually loves a big open container for regular and/or red bag trash because it doesn’t need to be emptied too frequently and is easy to access without contaminating a countertop or cabinet surface. As these do not contribute to providing a patient-centered design environment, work with department staff and housekeeping to explore alternatives for containing and stowing waste. Options can include using smaller containers, or ones purchased based upon their ability to blend in aesthetically with the design. In some cases, where large volumes of trash are not likely to be generated, it may be possible to use containers that can slide under a counter or pull out from a cabinet like a drawer.

The patient experience and outcomes are affected by things we often fail to truly design. Far from being boring, thinking about infection control issues may be the most important decisions we make.