Designing for health and wellness is inherent to architecture. At HED, great architecture is rooted in real world outcomes that foster healthier spaces and environments. Today, the firm's healthcare team works to deliver progressive medical care facilities grounded in continuous learning, adaptation and experience. As the firm's National Healthcare Design Leader, Alberto Salvatore is working to inspire a Culture of Health across the United States.
In an exclusive interview with ArchDaily, Salvatore explains HED's background, as well as his personal aspirations for how we can begin to reimagine healthcare design in the United States.
Can you tell us more about HED and its mission?
HED is a group of passionate, talented, individuals working together to design positive experiences for people in spaces in and around our buildings, and communities where people live, work and play. Our firm has a long history and reputation for design excellence because we believe that all the facets of our design, from architecture, consulting, engineering, and planning, must create a positive impact for our clients, the community, and the world. We believe that design is not neutral. It either contributes positively or negatively to our experiences. Our mission is to make a positive impact through design excellence in our interactions with our clients, understanding their business goals and developing strategic methodologies and designs to address those goals, culminating in exceptional results.
What kind of projects do you personally work on?
As the National Healthcare Design Leader for HED, I have the opportunity to contribute to the design in all stages of a project from functional programming through construction administration. I am currently working on a new rehabilitation hospital for Mary Free Bed at Covenant Healthcare in Saginaw Michigan and have just completed a renovation project for a Primary Care Clinic for Martha’s Vineyard Hospital in Massachusetts. I have led projects of all sizes, from a 3.5 million square foot facility in Saudi Arabia, to a single Interventional Cardiology Imaging room.
Recent events with COVID-19 have been swift. As the National Healthcare Design Leader at HED, how do you think this pandemic will shape the way we think about healthcare design in the United States?
Models of care have developed over time to respond to the continually changing healthcare landscape. Patient Centered Care emerged in the 90’s, and Family Centered Care in the early 2000’s. As a result of this pandemic I believe that the new care model will become “Community Centered Care.”* Community Centered Care will push us to understand the value a systems approach to designing Health Districts, stressing hyper collaboration, developing interdisciplinary teams that create appropriate environments of care for daily living, as well as the creation of plans for emergency management of natural disasters and pandemics similar to the one we are experiencing today. This approach will blur the lines between the silos of healthcare, education, transportation, finance, nutrition and the supply chain, to name a few, and the result will be more sustainable, resilient communities.
At a more micro scale, this pandemic is teaching us that reducing the spread of infections and maintaining high levels of cleanliness are extremely important – both long-standing hallmarks of the healthcare industry. Many procedures that hospital designers have practiced can, and now clearly should, be implemented across a wider array of buildings types. From copper handles, to improved ventilation designs, to interiors targeted at cleaning efficiency, I am sure these things will soon appear in design conversations across other sectors to promote a healthier environment for future generations.
What are some design challenges that are unique to healthcare facilities?
Healthcare Facilities are arguably the most complex building type of all. They contain virtually all other building types: laboratories, gyms, hotel rooms, restaurants, classrooms, etc., along with all the highly technical clinical care spaces. They also span the total spectrum of emotional experiences that people can have in a facility from a celebration of life in birthing suites and nurseries to morgues and viewing rooms where the strongest feelings of grief and loss are experienced. The design of these spaces requires an understanding of how each piece of equipment operates and its service requirements, how the overall department works, and how that department fits into the overall operation of the hospital as a whole.
With many firms transitioning to remote work, what tips would you provide to firm leaders?
Prior to working for HED and other larger firms I had my own successful small, virtual practice for almost 20 years. We are so much better prepared to work remotely now than we ever were. The tips I would offer other firm leaders are to use all the available modalities:
- Empower your teams by supplying the appropriate tools, hardware and software to increase the likelihood of efficient and effective workflow.
- Continue to encourage the development of respectful relationships between all team members. Trust, accountability, and culture are more important than ever.
- Communicate, Communicate, Communicate. Set up morning check-in meetings to assure all members of the team have a clear understanding of their information needs and expectations related to outcomes.
As this pandemic subsides, please do not go back to business as usual. Learn from how efficient you can be virtually. Reduce your footprint in office space to only what you need. Reduce your overhead, potentially increase your profit margin.
Within the last few weeks we’ve seen many design ideas emerge, from utilizing hospital ships to mobile health units and ICUs like Jupe. Do you believe these ideas can help us in future pandemics, or address some of our existing healthcare needs?
I believe that hospital ships can help us care for the non-COVID 19 patients to allow more space in our hospitals to address the more critically ill patients. The Jupe creators certainly have an innovative concept that will be applicable where appropriate. CURA is another enterprise, coming out of Italy, that is transforming existing 20’ long shipping containers into 2-bed ICU units. Any of these emerging design solutions should be evaluated based on the clinical needs of the patients that are to be cared for, and the spaces that are available to deploy said solutions. I see these design efforts as required in our current situation, but at the same time reactionary.
Regarding future pandemics, I believe that we must finally embrace the new definition of HEALTH offered by the Robert Wood Johns Foundation, the WHO and the CDC. This definition states that Health is defined by four major factors and Healthcare, or Clinical Care is only one of those factors and contributes 20% to ones’ overall health. Healthy Behaviors is 30%, Social and Economic factors are 40% and the Physical Environment is 10%. This definition supports the previously mentioned care model of Community Centered Care. Clinical care and research will always play a critical role in developing responses to our future pandemics, but as we design the future environments where we live, work and play, if we do this while looking though a “Culture of Health” lens to inform our design decisions, we will be better prepared to manage future challenges.
As you look to the future, are there any ideas you think should be front and center in the minds of architects and designers?
The development of the “Culture of Health” lens should be embedded in our design process. Every design starts with an inspiration. I, along with others I am sure, believe that if we use HEALTH as the inspiration to transform our practices, then we can not only transform our buildings, but also our communities and, once and for all, our planet. I also believe that architects and designers are, at our core, public health professionals. We should embrace that opportunity and, at some point soon after all of this, the collective responsibility to have an even greater impact on our community’s health through our designs.
*The Community Centered Care concept can also be found in the appendix language of Section 1.2-4 Environment of Care Requirements of the 2014 Guidelines for the Design and Construction of Hospital and Outpatient Facilities (Guidelines) 1.2-4.1 Delivery of Care Model Concepts. The idea was originally drafted by Salvatore as a part of the Environmental Standards Council for the Center for Health Design.
We invite you to check out ArchDaily's coverage related to COVID-19, read our tips and articles on Productivity When Working from Home and learn about technical recommendations for Healthy Design in your future projects. Also, remember to review the latest advice and information on COVID-19 from the World Health Organization (WHO) website.