Public health and the built environment have a long-intertwined history—one that was catapulted into the limelight amid the COVID-19 pandemic. The global crisis made us all acutely aware of how design, whether for dedicated medical buildings or other building types, can affect our ability to respond to health emergencies as well as our daily well-being. Those most attuned to this connection are a niche group of architecture and design practitioners who also have medical experience.
Metropolis recently sat down with three members of this unique subset: an intensive care unit manager who also serves as a senior consultant for CannonDesign, a geriatric internal medicine physician who doubles as a healthcare principal at Jacobs, and a surgeon leveraging his medical experience as a senior principal and chief medical officer for HOK’s healthcare practice. Beyond impressive résumés, these hybrid professionals bring an unparalleled boots-on-the-ground perspective to healthy design. Here, they share their insights, discussing how health care design methodologies have evolved in recent years, the ways they’re collaborating with design teams in the wake of the pandemic, and where they see heightened interest in health and well-being in the design of non-medical spaces. —Lauren Volker
ANDREW M. IBRAHIM, MD, MSC
- Chief Medical Officer, Healthcare, HOK
- Assistant Professor of Surgery, Architecture, and Urban Planning at the University of Michigan
- Co-Director for Healthcare Outcomes and Policy at the University of Michigan
- Surgeon, Ann Arbor, Michigan
The front line of health care is among the most complex and high-stakes environments of any profession. Medical professionals are constantly looking for ways to clarify purpose and simplify processes to ensure best patient care. As our designs for buildings get more and more complex—code requirements, new materials, emerging technology—health professionals may find their most valuable service is helping bring clarity and focus to what really matters most.
Since the pandemic, data-driven decisions have taken center stage. While previous design decisions always took trade-offs into account, the unprecedented focus on climate and sustainability—as well as hospital efficiency and capacity—has made real-time understanding of quantitative data incredibly important. More and more, data-driven econometric modeling strategies are guiding our large design decisions.
The pandemic has given us not only permission but a mandate to be more innovative. Designing health care spaces to include natural air ventilation and retractable roofs may have seemed far-fetched before, but now these important concepts—which are common in stadium design and airports—can have a meaningful role in health care facilities. As such, many teams now include members across multiple disciplines and with experience in diverse building typologies to realize a more innovative design solution.
Health is now more central to almost everything we design. Over the last three years, I have seen non-healthcare projects grow to more than half of my portfolio. In short, health matters to everyone, and we can use design intentionally to make all parts of our life—where we work, eat, rest, and play—healthier. So many of the principles that I use as a doctor to help patients live healthier lives are crossing over into the way we’re designing everyday space for health.
DIANA ANDERSON, MD, M.ARCH HEALTHCARE PRINCIPAL AT JACOBS
- Cofounder of Clinicians for Design
- Instructor of Neurology at Boston University
- Geriatric Neurology Fellow at VA Boston Healthcare System
Health professionals can provide insights into health care operations and, most importantly, patient needs and experiences. These perspectives represent a unique opportunity for architects to experience the world of clinical medicine in a way that is typically hidden. We can walk the halls; we can talk to physicians and other clinicians; we can shadow individuals as they go about their daily routines. Having health providers participate in projects also promotes a data-driven design process, strengthening the built environment to benefit health outcomes.
While the clinical practice of health care and the fields of architecture, planning, and design have traditionally occupied different professional, social, and cultural worlds, emerging professionals are asking to move beyond these infrequent intersections and seek a convergence of career models through the domains of research, education, and practice. This movement has accelerated during the pandemic given the need for rapid, innovative, and often design-based solutions to many problems.
The pandemic exposed the need for a shift toward a data-driven design process, and the role buildings play in our physical, mental, and social health. One striking example is research that demonstrated that smaller-scale nursing homes had better outcomes—significantly fewer COVID-19 infections, hospital admissions, and deaths. What concerns me is the reactive approach to the design seen during the pandemic with infection control as the main driver, which in my mind is only one element of health design. Ensuring quality of life and health (which includes mental, physical, and social health) for those who use health care spaces should still be paramount.
We can certainly create sealed spaces to keep infections at bay, but there is often a domino effect. We have seen the negative health effects of social isolation and loneliness—in medical settings, research has shown that long-term-care residents without personal contact with family or friends experienced greater excess mortality early in the COVID-19 pandemic. And this concept spans all spaces and environments. The detrimental effects of forced social isolation can be mitigated through design, even within our own homes. For example, views of nature at home have been shown to reduce levels of depression, loneliness, and anxiety, sometimes more than the actual use of outdoor green space itself. Design of the built environment at all spatial scales—from our homes to our neighborhoods and cities—is a determinant of health.
KAELEE STONE, MHA, BSN, RN
- Senior Consultant, Blue Cottage of CannonDesign
- Intensive Care Unit Manager, CHI Health St. Elizabeth, Lincoln, Nebraska
When you spend every day working in health care spaces, you’re able to see what is and isn’t working for patients and staff at an entirely different level. No designer or team can imagine or simulate all the different scenarios those of us working in the field may live through. Health professionals can point to certain furniture, equipment, tech, or designed workflows that might be aesthetically pleasing but create inefficiencies.
We all remember the intense stories from the early days of the pandemic when medical teams lacked PPE and healthcare institutions didn’t have enough space to properly care for patients. The ingenuity health care showed at that moment still inspires me, and many of the ideas that teams came up with in those moments were carried forward into today.
But at the same time, health systems recognize that global pandemics are inherently unique and are focused on bigger-picture ideas that improve care, pandemic or not: spaces rich with flexibility, beds and patient rooms that can more easily be upgraded to accommodate critical care, self-cleaning materials, and strategies for making isolation less lonely. All of this adds up to important change, but it’s not entirely about future pandemic prevention.
An interesting example of this can be found in our current work with the University of Cincinnati (UC) Health. Our teams at CannonDesign and Blue Cottage of CannonDesign have helped them incorporate a remarkable level of flexibility into the design of their new emergency department. Once complete, it will feature a separate entrance with mass triage space and a 32-exam-room pod that can run in “pandemic mode” to treat infectious patients. These responses empower UC Health in the face of a future pandemic, but also in a variety of other scenarios.
Blue Cottage of CannonDesign also works across all different sectors, and we’re seeing education and commercial spaces infusing more health and care resources into their environments. Health care providers who also work in design can directly impact these projects. I’ve always felt that designers and providers care about patient experience in their own unique ways. And when you can combine those unique perspectives and passions on a single team, that’s when the real magic happens.
This article was originally published in Metropolis Magazine.
