Homemaking: Urban living meets affordability

Top: the Micro-Unit Prototype
Above: The What's IN team: from back moving left to right: 
Ben Stracco, Mika Gilmore, Lisa Walden, Marcus Hamblin, 
Fred Kramer, B.K. Boley, Tamara Roy, Blake Goodwin, 
Zach Pursley, Ruthie Kuhlman, Meredith Powell, 
Melissa Miranda, Aeron Hodges, Derrick Nickerson, 
Michelle Kim, Quinton Kerns, Dan Connolly, Chris Neukamm.

We take for granted the amenities around us.  We are (mostly) warm, safe and dry, yet often feel discontented with our space, not because it fails to provide for us, but because it fails to enrich us.  Whether it's that cookie cutter subdivision home with its oddball "feature" spaces, the dreary big city walk-up apartment that barely meets any kind of building code or something in between, so few of us have the opportunity to live in a space that really supports how we want to live in it.  But what if the reason our living spaces fail us is because we don't have the right expectations for them?  What if you could throw out everything you thought you knew about how to live in a home and started over?  The subject of my master's thesis at the University of Arizona was the impact of telecommuting on our understanding of the home.  Part of the research I did involved looking at the evolution of our understanding of a home.  Most of us are stuck in a model that comes straight out of the Victorian era, where urban equaled bad and the domestic sphere needed to be clearly separated from the sphere of work.  But we don't live in the Victorian era anymore, so why should our spaces?

What's IN is trying to answer that question.  This exciting urban housing research project includes the Boston design groups ADD Inc and One-In-3 as well as MapLab and local mosaic artists Artaic and has undertaken a study of the demographics and sociographics of urban housing today and proposes ideas on how to best meet the live/work needs of young professionals.  It's a national trend that young college graduates are looking for the urban lifestyle in ever increasing numbers.  So are aging baby boomers.  To the extent that a city can provide the housing they seek, that city can prevent a "brain drain" of young, innovative and educated professionals.  So what stops them?  Affordability and amenity are the two big issues.  This group is attracted to the vibrant, culturally rich and diverse environment found in urban neighborhoods, but not the price tag that necessarily comes with it.  What's IN's solution: the Micro-Unit.

Defined as a single family dwelling unit ranging from 250-300 square feet, the Micro-Unit has stripped living down to its essential elements; bathroom, kitchenette, storage and living/sleeping areas.  Borrowing a page from European and Asian models (and ancient Roman city life for that matter), What's IN offers the larger spaces we have been conditioned to believe we need within our dwellings outside of them in the form of communal social spaces.  This not only allows the units themselves to be more affordable, but fosters the kind of neighborliness that studies show keep our communities safe and vibrant.  Says Quinton Kerns, one of the group's founders, "With minimal/durable use materials we can minimize cost of construction and with the re-imagined unit sizes we can provide more density within a floor than what is currently offered with most market rate units. The Micro-Unit seeks to tackle the ongoing problem of affordability in urban housing coupled with the opportunity to foster a social revival in our local communities."

This is real research- the group conducted polls, looked at product options, studied prefabrication techniques, investigated design precedents from all over the world, and looked at real estate issues.  They also partnered with business and civic leaders to talk about the issues involved in making their concept take off.  What did they learn?  Affordability trumps all.  In perhaps a crushing blow to most designers, futuristic, gadgety, multi-tasking furniture was soundly rejected by the focus group.  Based this information, they determined an ideal unit size (300 sf) and features to include in a prototype microunit, with smart features important to urbanites, including bike storage and casework that could be user-built a la IKEA to save money.  A mockup of the unit was then constructed by the What's IN team.  To get the widest possible range of feedback, the mockup went on tour at prominent Boston venues ABX 2012 at the Boston Convention and Exposition Center, the Atlantic Wharf lobby adjacent to the BSA Space, and The Modern Theater at Suffolk University. The group created a survey to allow mockup viewers to weigh in on how well they think such a living arrangement would or wouldn't work for them, in addition to providing key demographic information to help inform the development of future microunit initiatives.  "The unit has been donated to Suffolk University so that students and faculty can utilize this model to engage the business and academic communities in and around Boston as this movement for approachable living becomes a reality," says Kerns. "What's IN is currently venturing into a deeper research initiative focusing on the social/community impacts for this new housing typology by means of further crowd sourcing, community surveying, community outreach, and a continued discussion with policy makers at City Hall. We are looking at displaying our findings at this year’s ABX 2013 with the ultimate goal of having some solid development in the works by the year’s end." 

The group's Tamara Roy presented What's IN's work to date in late March 2013 at a housing Forum at Suffolk University. Her presentation powerfully illustrates just how much a shortage of affordable housing impacts the city, and the innovative approach to solving this problem that the group developed.  "We believe in the power of tiny things and the Micro-Unit speaks to that idea," says Kerns. "Through our research we found that city dwellers are not only willing to share living, eating, and social areas within their living environments, but they really want these amenities to be more social! And through this call for more social living we are faced with a great opportunity for innovation. Diversity + Density + Interaction = Knowledge Spillover...by the nature of what they are, micro-units foster innovation!"

Key What's IN Players:
Tamara Roy: Senior Associate Principal at ADD Inc and “Mother of the Micro-Unit” in Boston.
Aeron Hodges: Designer at ADD Inc, Co-Founder of the WHATS IN initiative and target demographic of the emerging families.
Quinton Kerns: Designer at ADD Inc, Co-Founder of the WHATS IN initiative and target demographic of the single young professional.
Fred Kramer: President of ADD Inc, Supportive Powerhouse and target demographic of the empty nester.
Chris Neukamm: Designer at ADD Inc, Committee member of WHATS IN
Michelle Kim: Designer at ADD Inc, Committee member of WHATS IN
Dan Connolly: Project Manager at STA, Committee member of WHATS IN and member of ONEin3
Blake Goodwin: Director of Operations for Artaic, Committee member of WHATS IN and member of ONEin3

Remedies for Healthcare Design: Major industry directions you need to address

Sometimes as architects, we get so myopically focused on what we do, in the process of design and project delivery, we fail to see the biggest picture. Our clients and colleagues often suffer this same malady, leaving us in need of a new place to go to seek perspective, and get out of the healthcare design echo chamber. One of my sources of choice is MedCity News. Founded in 2008 by Chris Seper, MedCity is a clearinghouse for information on all things related to healthcare and life sciences (which I often find includes many other aspects of design as well). Precisely because of his vantage point as a journalist, not a designer, with his finger on the pulse of macro issues impacting healthcare world, Chris has some amazing insights into what we’re missing:

There’s been a lot of focus lately on the patient experience. How do you see these trends impacting healthcare spaces themselves?
Patient engagement is emerging as a big issue, as healthcare consumerism rises. This will include a bigger emphasis on wayfinding, guiding patients around the hospital, as well as designing hospitals to provide more information through integration of data and organization of the space. It is also important to make the hospital feel less institutional and more welcome. Hospitals are the least inviting of any buildings, but now they are the largest buildings being constructed in most cities. For example, when you compare past architecture and current major building projects here in Cleveland, you are comparing structures like Symphony Hall and Playhouse Square to the University Hospital’s Seidman Cancer Center and Cleveland Clinic’s Sydell and Arnold Miller Pavilion or the Medical Mart. Healthcare will sculpt the face of many of the metropolitan areas of the country, it’s where the jobs are and the donors. There is an external aesthetic, and a legacy that will be written by hospital designers, something that was not even thought of seven to ten years ago. City planners will wake up too late to understand how to integrate them into the urban context. In 50 years, these hospitals will be the historic buildings we will be looking at. It’s an unknowing legacy.


How important do you think employee satisfaction will become in healthcare? What are some ways that amenities offered in the work environment will affect this?
You hear about shortages of high quality talent, but the indicators are that this is a buyer’s market. Many physicians are running to be acquired by health systems. Nurses have suffered notoriously poor treatment and are being laid off. Unless you are a rock star clinician, most systems will treat you like a widget. Any changes to your environment will be based on how it will extract value to patients because of the emerging reimbursement model and business model. The answers for shortages are to leverage technology and increase productivity, i.e. telemedicine.


How can design work to support the technological change taking place in the way healthcare is delivered?
There’s a lot of product fulfillment going on, leveraging RFID, sensors, wireless networks, better inventory management. There needs to be a level of consideration of how you manage and supply these systems. How patients flow matters, but so does inventory management to avoid over or understocking of supplies and correct delivery of drugs. Security will also be a bigger issue. How do you design a hospital where these are no visiting hours and people come and go all day?
I was at the Digital Health Summit this year and came away realizing that there were three major issues impacting healthcare; changes to government policy on reimbursement of sick care vs. management of wellness, the food people consume or are forced to consume (i.e low income residents of food deserts), and unlocking the desire of human beings to be healthy. Most people who need health and wellness don’t seek it or can’t do it. Most people who do seek healthcare are the worried well. Therefore, hospitals are dealing with managing the seriously ill or crisis conditions, while at the same time trying to pivot their focus on wellness.

We are a third of the way at most to achieving optimal healthcare delivery. Despite the resources out there for people to manage their own health, no physician is going to trust information gathered by a patient. Technology is still in the background. Mobile apps are useless when it comes to the clinical diagnosis of your problems because the rules and regulations and ability to quickly scan or tag information is still not there. There is also still a tendency to look to a clinical solution instead of a lifestyle one. For example, they are inventing all of these high priced ways to deal with sleep apnea when the number one way to deal with it is weight loss.


As architects, we often have to place design in the context of a hospital’s value vs. cost propositions. How many of these emerging value scenarios will actually improve quality through innovation in delivery of care or process?
Innovation is the biggest challenge. If there’s one thing healthcare is panicking over, it’s how to change their innovation and interface. Motivations have changed. How do you leverage data, and keep it accurate and of high quality, much less tap into big data potential? Everything has been structured for silos. Healthcare over the past ten years has moved into a real overall ROI through cross pollination of ideas. A hospital will spin off and partner with early stage companies in ways they never would have in the past and pharmacy companies will pursue a mobile app as aggressively as they would have a molecule. The whole ecosystem is changing, but the structures have not changed with it. An triumvirate of healthcare has emerged; patients/customers, clinicians, and the B to B side. One of the things we have been able to accomplish with Med City is to provide a forum for all sectors to interact, especially the underserved B to B side of healthcare.

Chris Seper (chris @ medcitynews.com) is the CEO of MedCity Media, which publishes MedCityNews.com. Chris drives the culture, oversees business and editorial directions, and manages the governance of the company (he also writes periodically for MedCityNews.com). Chris is a former journalist turned media entrepreneur who launched MedCity Media in December 2008. He sits on the board of directors of The Civic Commons and the advisory boards of Spoke Software and Your Teen Magazine.

Winning the Battle and Losing the War

It’s the rare client who has the foresight to truly master plan- rarer still the one who authorizes a capital project based on forecasted need instead of waiting until renovations/expansions are way past their due dates.  When everyone’s working conditions are obsolete and overcrowded, the very way work is done is affected.  The workplace becomes the war zone with erstwhile staff in the trenches every day just trying to keep things functioning.  No wonder it’s so hard to think differently about space.  In healthcare design, we can no longer afford to keep with the status quo “adapt and react” mentality when it comes to buildings.  This mindset brings about a shortsightedness that satisfies an immediate need at the expense of truly solving a problem.  I recently had an opportunity to hear a presentation from Debbie Gregory, Senior Clinical Consultant at SSR and Nursing Institute for Healthcare Design (NIHD) Board member.  Debbie also has a background in interior design, so she understands healthcare design from multiple viewpoints and I enjoyed listening to her insights regarding what healthcare clients are looking for from their architects.  Some thoughts from the battleground:

Avoid conflation
Sometimes an expansion is definitely in order.  Others, reorganization of space is the better option.  While healthcare facilities are getting bigger in part due to larger room sizes, more equipment and the need to have more adaptability built into units, there is also the tendency for clients to ask for (and get more ) of the same space they had before just 30% -40% bigger.  All the same work habits and processes are baked right into the new space. Right size based on criteria related to flexing acuities, innovative technologies and equipment or increases in volumes, not to accommodate inefficient processes that have arisen out of the current physical features of the space.

Beware of collateral damage
Just as teaching to the test leads to peril in the classroom, designing a delivery of care model around scoring enough HCAHPS points is disastrous.  The point of metrics is to measure performance, not how well you can game the system.  If you are providing the best care, you don’t need to worry about metrics, just as a great teacher never needs to worry about how her students will score.  Learn to recognize well-intentioned policies from infection control, facilities or the C-suite as intentions that may not apply to the unique needs of your particular situation and work with them to develop a solution that meets the “spirit” of the law, not just its “letter.”

Know your enemy
The biggest enemy of innovation is the routine.  It’s very hard to break out of the way you are used to doing things, or to question why you do some things at all.  One thing I think we fail to be taught as architects is how to help our clients re-frame the problem.  Sure, we know how to turn an idea on its head, but we may not be attuned to all of the issues related to care.  We also tend to spring these “breakthrough” concepts on our clients, often to mixed reception.  What we really need to be doing is to help them walk through the process and think about what they do and why every step of the way.  Don’t create tomorrow’s problem with today’s solution. Mockups, done at a conceptual phase of the project can help to right size an element like a patient room, which will drive overall program and square footage needs.  Debbie strongly recommends that you conduct the initial viewing of the mockup as a moderated discussion in order to keep department stakeholders focussed and make sure that everyone’s voice is heard, not just the squeaky wheels or department leadership. 

Break ranks
It’s not about keeping the building as we know it, but rather making the building into what we need it to be.  As conduit for healing- the healing environment has a big role to play in patient outcomes as well as staff satisfaction.  With greater emphasis on providing value being placed on today’s healthcare providers, we must think about how buildings contribute to that equation.  The value proposition should include links of design elements to measurable outcomes, such as reduced injuries, hospital acquired Infections or satisfaction scores; recommendations related to achieving the lowest life cycle costs, and agile planning and infrastructure solutions that will respond to emerging needs instead of requiring costly and constant additions.


None of these strategies are about adapting or reacting, they rely on a great offensive strategy where the patient doesn’t end up being the casualty of our planning effort.

Aspiration vs. Inspiration

Most of us are not unfamiliar with achievement.  On the battlefield of office politics, project expectations, and ever shifting work paradigms, we focus on scoring small victories daily.  We are also not without ego.  We want to do amazing work and have that work be appreciated and recognized.  But, with so many metrics by which our performance is judged, we can’t possibly dance to all those tunes.  How many times do you find yourself settling into a single mode, putting on, say, your sustainability hat to the neglect of managing things, or your manager hat to the detriment of thinking outside the box?  Let’s not even go to lean thinking, silo-busting, or ROI.  We’ve been conditioned to aspire, and that soon becomes our undoing.  That’s because aspirations are external motivators- other people’s ideas of success.  Attempting to please everyone muddies the waters and results in mediocrity, especially when the goalposts keep moving as new metrics get developed.  Aspiration is a treadmill, not a path.  It’s time to hit the off switch on these bad habits:

Exceeding Expectations
Implicit within this lovely catchphrase phrase is the idea that the expectations were clearly communicated and that they contained some threshold for clearly measuring success; which is not really in fact what will be considered success as you should have exceeded it.  In this economy, our clients cannot succeed if they pursue mediocrity and they hire us to access and facilitate fresh thinking.  Transformational projects never arise out of metrics.  They arise out of questioning existing patterns and habits and freeing ourselves from expectations.  Stop handicapping your vision. Instead of asking, “what now?”  ask “what if?”

Expectations are also tied up in emotion.  The fear of not meeting expectations leads everyone involved to play it safe.  That isn’t inspiring to anyone.  Instead, try pulling back to a more logical viewpoint, one that justifies thinking big by providing a path to get there. Focus on the solution and the trials and tribulations of the process will seem less onerous.

Marching into the Abyss
Of course we would like our next project to be user-centered, efficient, restorative, and transformational.  Of course we want to collaborate with the project team to leverage expertise and find innovative solutions that are faster to build, more cost effective that the traditional ones and save even more money over the life of the project.  Of course we want to attract and retain the best staff, satisfy our patients, residents or customers, and generate positive marketing. That some enterprising souls have found ways to codify these things (LEED, Lean, Evidence Based Design, organizational management, BIM, etc.) should make it easier for us - right?  Eh, not so much. 

When you try to add project expectations and tools together like a layer cake, you don’t get much real benefit from them.  Moreover, you drive yourself and your project team crazy chasing rainbows.  LEED, for example, can actually hurt the project’s overall quality *gasp* not because LEED is inherently evil or that sustainability shouldn’t matter, but because you aspired to be sustainable instead of being inspired to provide a better environment.  When we lose focus on why we are building in the first place and get distracted with “measuring up,” we start doing things that are not in alignment with the project goals or our personal ones.  We miss opportunities to enforce these goals in ways that would probably blow the doors off the LEED scorecard.
 
Chasing Proficiency
Scattered energy impacts nothing.  Trying to follow all of the buzzwords and metrics is more than just exhausting, it obscures your clarity.  Let go and start practicing with purpose.  When you know what you are all about and pause to plan how to express that in your work, you suddenly find yourself passionate, energetic and clearly communicating your vision to others.  Your inspiration leads them to be inspired as well.  This alignment of purpose and passion creates the focus that allows us to achieve the seemingly impossible. It is this distilled message and effort that leads us to mastery over mediocrity.  Mastery is what our clients crave and seek out, what the market rewards. Achievement is not about ego, which is limited by aspirations of what “should” be.  Instead, it is about having a consistent philosophy that can be understood by others. When you are functioning as your highest self, others will see you that way as well.

Simplify and pare down instead of frantically rushing to adopt whatever trend you recently read about.  Focus on the things that really matter to you and design on purpose instead of by default, allowing all the checklists, codes, technologies, requirements and strategic alliances to limit your vision then using that as the excuse for why the project wasn’t better.

Aspiration is playing into the expectations of others, inspiration is following you own path.  Do you want to get somewhere or not?

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.