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.

Liberation: six steps to set your creativity free

Does your thinking always default to “fault?” Are you trapped in an endless game of “gotcha” with yourself?  Have you imprisoned your creative spirit in a cage of self doubt? As someone who expects perfection out of myself I can relate to the fears and desire to overachieve and exceed expectations that hold creative people back.  I recently read an excellent article on letting go by Tony Schwartz that got me thinking about how we can set ourselves free of things that don’t serve our highest self in order to make room for the things that do.  Sounds like a scary proposition- but it’s not.  What it is is nothing short of liberation.  Just as fear of failing can immobilize us and keep us stuck in a rut, letting the perfect be the enemy of the good causes us to aim low, and apologize for taking chances.  It causes that judge and jury in our heads to consistently level a guilty verdict. This is my list of six common creative prisons and recommendations for breaking out:

Shackled to the past
Maybe it took you a while to really get the hang of model building, or a design program.  Maybe you got some harsh criticisms of your work.  Maybe that first internship was a bit rocky as you learned the ropes.  Maybe, just maybe you learned from all of this and are now competent.  However, you got used to viewing yourself as inexperienced and mistake prone.  That self-image no longer is a true representation of the architect you are today.  Like the person who’s conquered a lifelong weight problem, and can’t stop seeing themselves as fat, you are locked inside your initial years as a fledgeling architect. Re-write your resume, update your LinkedIn profile, do something to affirm the architect you are today and keep celebrating that in order to change your self image so that you can feel empowered to make decisions from the point of view of who you are, not who you were.

Confined by busywork
No one ever says on their deathbed that they wished they’d worked more.  If anything they probably wished they’ed enjoyed life more and made more of an impact.  No, you can’t blow off deadlines, but you can prioritize.  Are you letting your to-do list be your excuse?  Whether it’s deadlines at work or personal projects, not giving yourself permission to move forward is not only silly, but it makes you feel so uninspired that you probably won’t actually get all those tasks done anyway.  You eat a pie one bite at a time.  At the beginning of each day, look at what parts of your life goals you can accomplish on that day.  It may be a single task and that’s fine because it advanced your agenda.  Contract, distill and excel.  When you say no to the expansive opportunities before you in order to scratch off some (insignificant in a global view) task, you are really saying no to your own expansion.

Locked into Entitlement
Do you brood about what’s not right or not fair in your career?  The client who treated you poorly, the promotion you didn’t get?  Do you beat yourself up over every real or imagined misstep?  The root of those feelings is an unyielding and harsh view of yourself as all or nothing.  Like a teenager, you believe that you deserve certain things and that life is lived at the extremes of always and never.  As your mother probably told you then, “life’s not fair.”  She was right.  Life’s not just about you.  The people you interact with have their own motives- you are far better served when you focus on understanding them because what really matters is the result and how you respond to a situation, not all the things that happened along the way to cause it.

Energetically in Isolation
You might think you took the high road by not telling your boss off, or giving that unappreciative client a lecture on the value of your service.  But you are still holding on to the resentment and it colors all of your future interactions not only with the individual in question but with others in your professional and private life as well.  Realize that by being non-confrontational, you are choosing to make yourself invisible- no wonder you aren’t on these people’s A-List.  Think about your passion for what you do as a ball of energy that lives at your core.  The more expansive the energy, the further out the glow extends.  Other people are attracted to that glow and want to work with you.  The greatest architects have such expansive energy that people will crowd into lecture halls to hear what they have to say, buy their monographs and wish they could work for or with them.  When you can’t let go of all of your resentments or regrets, you diminish your energy.  Think about that glass-half empty colleague or friend  How drawn to that person do you (or clients) feel?  Then realize that, at times, we are all that person.  Choose to be aware of when you are letting your anger, doubts and fears diminish your energy.  Then take steps to let go.  Stop suppressing your emotions and instead think about whether you actually made your point of view heard.   Calmly and with an open mind approach the person and ask them to recount their decision/actions from their point of view.  You may be surprised at what you learn.

On the chain gang of Trying Too Hard
Are you trying to make your clients like you more by practically wiping their noses for them?   Score points with your boss by being a workaholic?  Being a doormat diminishes your expertise and loses any respect people will have for you.  A project is a partnership and all involved have to understand their roles and responsibilities.  Decisions and directives (or lack of them) have consequences.  Don’t try to sweep client driven issues or office problems under the rug and cheerfully try to compensate by doing others work for them.  So often, we try to just make our situation work and do it all. You never want to put yourself in a position of being held accountable for an outcome in an areas where you have no responsibility. Your boss and your client’s main objective is to have a successful project.  If they aren’t giving you what you need to accomplish this, the greatest service you can provide is one of coaching them on how they can help make the outcome a success. 

Rotting in the dungeon of the Status Quo
What’s good for General Bullmoose is not necessarily what’s good for you.  If you are trying to live up to the expectations of your family, co-workers, society, you are engaged in conformance.  Conformity erodes creativity.  I am not suggesting that you have to be an angry, angry artist who rejects the world in order to be successful.  I am telling you that you need to know yourself and make decisions because they are right for you.  Unfortunately, we’re all likely to hit cruise control when we feel that our lives are basically going in a good direction.  It usually takes some disruptive event to create a breakthrough.  Why?  Because being shaken out of your status quo stupor makes you refocus on what really matters to you.  In the disruptive state, you reject limits and question rules.  Make bold, purposeful moves in your life and you will fail, but you will also succeed beyond your wildest dreams.    When you take actions with purpose, not just because you can or should, miracles can happen.

Who caged your creativity? Who cares?  What’s important to remember is that you hold the key to your own creative freedom. Unlock your own liberation.

Wellness the Series: Urban Rx: Cures for Sick Places

My most recent article for Urban Times discusses ways neighborhoods can develop strategies to challenge blight.

Every city has at least one: the neighborhood with rampant crime, boarded up buildings, empty lots. Few stroll its streets and the businesses that remain have bars on the windows. This kind of place had a heyday once, but is now in a tragic state of demise. Often, such places are in strategic urban locations and ripe for revitalization. But, short of calling in the bulldozers, how does a neighborhood go about fomenting its renaissance? It starts with properly diagnosing the reasons for decline (every story is not the same) and working closely with neighborhood residents and businesses to develop the prescription to turn things around.

Read the Symptoms, Treat the Problem

A sketch I did showing the importance of mixed use and a variety of building textures, styles and colors as part of a charrette for the revitalization of Phoenix's Wilson neighborhood.

So often, response to urban decline is reactionary: high crime translates to constructing fences and more security, for example. However, responding defensively to a series of symptoms has the unintended consequences of creating an even more hostile environment, sending not the message of toughness, but a message that no one, not even the neighborhood residents, are very welcome in the neighborhood. Most people don’t understand this, neither do most planning and zoning commissions. Hence, we end up with everyone’s fears written into the codes, instead of everyone’s hopes.  Something like higher crime is usually a symptom of a greater urban disease, which is why applying the aspirin of “lockdown” to the cancer of urban decay seldom works.  What a community really needs to do is take a long hard look at itself and begin to look at social and economic factors that have changed for the worse, then look at strategies for making a change:

Urban decay Vandalism at the Broadford Works on Ann Street. (Photo credit: Wikipedia)

• Character is Brand – Most struggling neighborhoods are suffering from an identity crisis, while they know they need to have a more walkable community that feels safe and is clean, they need help figuring out their unique path to revitalization.  No two neighborhoods are exactly alike.  If you take the time to talk to the people who live there you’ll find out why they stay, and even more, why they’re willing to fight so hard for revitalization. That character, which is an experience not available elsewhere in the city, is what needs to be celebrated and cultivated in everything from the streetscape and plantings, to the type of businesses that are courted, to the density and style of the buildings. Think about traffic patterns and flows, the accessibility of parking and how parking impacts the feel of the space. The brand that develops is what can be used to court new businesses. Brand builds the expectation of the customer/user.  It needs to be based on a solid and clear vision, integrated as an experience, and it has to deliver on its promise.

• Leverage Assets – For any community, being able to achieve what it wants (its vision for a future), from what it has (its character and history) involves knowing what it needs. Copying what worked for another neighborhood is no guarantee of success. People are not attracted to generic, soulless communities to live, work and play. They are attracted to the quirky, wonderful little neighborhood with the interesting mix of shops and restaurants that is worth the trip. Once they spend enough time there, they may even become interested in living nearby. Communities must be being willing to start small – maybe just a few blocks on a main road to develop a critical mass. Look at the merchant mix and think about the message that it sends, then work with the owners of the businesses you want to keep to help them find locations where they can be grouped in a way that they help one another succeed (i.e. a series of restaurants and shops in a row).

• Get Momentum – Even the most thorough and realistic of plans won’t lead to revitalization if the community itself isn’t engaged. While it may be impossible to have complete agreement, it is not impossible to reach out to local businesses and law enforcement as well as grant programs and other opportunities available at a municipal level. Seeing these first steps of positive change allays fears and suspicion and encourages residents to be more involved as well because they can see the effect of their actions. Most struggling neighborhoods have plenty of missing teeth in the form of abandoned or under-occupied buildings and vacant lots.  However, in order to convince new businesses to locate there, a neighborhood must have some momentum going. Even something as simple as a streetscape improvement project shows a commitment to change and reinforces that all-important brand.  Don’t forget to grow entrepreneurs from local residents and always aim for authenticity.

Seek Alternative Therapies

Photo c/o dennoir (flickr)

While they may have had their place, traditional zoning codes with their restrictive description of uses have little relevance for the modern city.  Zoning codes are about achieving uniformity and compliance, not about cultivating character – kind of like Mom saying “no.”  What if, instead, we thought about codes as a list of everything you can do, should do, might do?  Form-based codes  are a great alternative for urban areas because they are not about segregating uses, but about encouraging density, walkability and character.  Many cities have implemented them and many more like my home city of Cincinnati, Ohio are in the process of doing so because they allow redevelopment to be shepherded in a way that reinforces identity of place over simply following rules.  Form-based codes focus on the fine grain aspect of experience, looking at things like human scale and pedestrian friendliness.  True to their name, this code system is less about land use than urban form, with an emphasis on creating public space shaped by private buildings.
Communities that take the time to really know their needs, and are willing to fight for them, do get better.  What’s critical is to stay true to a vision, pull the community into the effort, support local businesses and never stop improving.  Think of redevelopment as a bird flapping its wings – it can soar as long as it continues the effort, but can glide only so long before it will plummet.  It takes time, patience and tireless commitment for an ailing neighborhood to recover, but blight is curable.