The Center for Health Design Blog

May 28th, 2009

Posted by
Sara Marberry

Book Review: “Evidence-Based Healthcare Design”

cama2
In the past 12 months, we’ve seen several new books on evidence-based design hit the shelves. The latest is a great new reference titled Evidence-Based Healthcare Design (John Wiley & Sons in association with the American Society of Interior Designers) by healthcare designer Rosalyn Cama, FASID, President of CAMA Inc., and a board member of The Center for Health Design.

Cama’s book is a step-by-step guide of how to implement an evidence-based design process. Instead of an eight-step process outlined in the EDAC (Evidence-based Design Accreditation & Certification) program’s study guides, she condenses it to four – and still manages to cover all the bases, and then some.

As a practicing evidence-based healthcare designer who has helped to shape the field, Cama has served on many interdisciplinary project teams, which as she explains in the book, is an “important concept imbedded in evidence-based design methodology.”

In addition to a foreword by Georgia Tech professor Craig Zimring, Ph.D., chapters are sprinkled with (and in some cases, comprised almost fully of) essays by those involved in the case studies she cites, as well as other industry experts – a veritable “Who’s Who” of healthcare design. So, in that sense, this book is not only Cama’s voice, but the voices of many others as well.

Each chapter begins with a relevant quote from a famous person and ends with a checklist that summarizes the key “take aways.” There are also plenty of engaging black and white images – charts, drawings, photographs, as well as a group of color photos to add visual interest.

The book is an easy read with lots of good information and resources – another “must have” addition to the evidence-based practitioner’s library.

May 26th, 2009

Posted by
Sara Marberry

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Access to Capital Through HUD

Last month Jim Rasche and Dave Sheedy of Kahler Slater Architects traveled to Washington D.C. and New York City to meet with various experts on the Department of Housing and Urban Development’s (HUD) Section 242 mortgage insurance program, including the HUD loan officers themselves. Here is a very brief summary of what they learned:

1. HUD 242 is essentially a program that increases access to capital. An application process allows the government to thoroughly vet an organization and evaluate its debt capacity. An accepted HUD 242 application is like a seal of approval from the government that allows clients who may not be able to access capital achieve an AA or AAA rating and borrow at lower interest rates.

With no capital limit, the HUD 242 program is designed to be of most benefit to larger projects. HUD also has programs designed specifically for smaller communities (fewer than 20,000 residents) and certain geographies.

2. The application process has been streamlined; and the money is there. Applying still requires a significant investment of time, but they learned from the lawyers who have closed 90% of these deals that the money is there to be had. There is also a new element of the program – Design Build – for projects under $30 million.

4. Successful applicants have put together a team of experts to assist them with the application. One step in the process is identifying the capital project need. This is a service Kahler Slater provided in 2003 for the Grand Itasca Clinic and Hospital in northern Minnesota, which received HUD 242 funding for its replacement hospital.

It’s great that Kahler Slater took the initiative to become experts in this area. Who says architects just have to design buildings?

May 22nd, 2009

Posted by
Sara Marberry

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Tips for Winning a Design Award

This week, I attended the judging for Healthcare Design magazine Architectural Showcase issue in Chicago. About 129 projects were submitted and a team of 20 distinguished judges sifted through them to determine if they should be included in the issue and which ones were deserving of citation awards.

I won’t spill the beans and tell you who won (the issue comes out in September), but it was interesting to hear the judges talk about the submittals themselves and what it takes (besides outstanding design) to get a citation. Here are some tips:

1. Read and follow the submittal instructions to the letter. Don’t include your firm name in the submittal if it says not to (this just annoys judges). Make a checklist to insure that you have included everything that you’re supposed to.

2. Answer all the questions thoughtfully and talk about how you did what you did, not why. As one judge said, “Show me the money. Tell me how you are using evidence-based design or green design to achieve outcomes, not just that you used it.”

3. Avoid marketing jargon. Ask project designers, and if possible, the client, to help write the narrative. Judges can tell when narratives are written by marketing people rather than the people who actually worked on the project.

3. Invest in good photography and quality floorplans and/or renderings. Don’t just provide images of the pretty public spaces. Include a comprehensive collection of images that tell the whole story. Incomplete submittals are also frowned upon by the judges.

4. Don’t submit projects that don’t demonstrate any kind of design innovation or thinking. Look at past issues of the Architectural Showcase to see which projects made the cut and which ones received citations. See if you project measures up — even if it’s only in one or two areas.

May 20th, 2009

Posted by
Sara Marberry

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Intersection of EBD and EED

Yesterday, I heard a fascinating presentation at the Clean Med conference in Chicago about the relationship between “eco-effective design” (EED) and evidence-based design (EBD).

Mardelle Shepley of Texas A&M and Mara Baum of Anshen+Allen Architects did a research study in which they found that the two are indeed compatible. The term “eco-effective design” is theirs, and I think it is a better description than “sustainable design” or “green design.”

They plan to publish their results in the HERD Journal, but essentially they asked experts to help identify design interventions for each EED and EBD, created a matrix, and then had people indicate where they thought there was a relationship.

Clear intersections occur in design interventions in the areas of nature, positive distractions, materials, and daylight. And there are many others. Look for more on this to come, but I think it is time that we began to talk more about the two as compatible approaches and start integrating it into our work.

May 15th, 2009

Posted by
Sara Marberry

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Most Influential People

Healthcare Design magazine is publishing a list of “Most Influential People in Healthcare Design” in its December issue. Nominations are being accepted until June 12 and voting will begin on June 15.

Who do you think are the most influential people impacting the design and construction of healthcare facilities? There are many architects, interior designers, facility executives, healthcare managers, product manufacturers, researchers, professors, nonprofit/association leaders, and others in our industry who are making a difference.

Nominate someone now! Then go and vote.

May 8th, 2009

Posted by
Sara Marberry

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Communication Tips

I had lunch the other day with Julie Paradise, a communications consultant who specializes in speaker training. Many of her clients are in service industries, including architecture and design professionals. So, I asked her for some tips for those who want to fine tune their face-to-face communication skills.

1. Work on striking a balance between content and delivery skills. Content is our word choices, presentation organization, and flow and delivery is our vocal quality, use of eye contact, body language, and posture. Both are equally important but in a first impression, delivery always trumps content.

2. Try to think like your audience, even if the “audience” is only one person. What do they value? How do they feel about your subject or topic? By being audience-driven, you guarantee that your listener will connect with you and your presentation.

3. Be prepared, really prepared! Even seasoned presenters don’t “wing-it,” though it may look like they are speaking spontaneously - they’re not! Usually, they have thought through their remarks, created a pattern of organization and included talking points and short narratives that will help their presentation flow.

4. Eye contact? Use it or lose it. We’ve heard this before but new research says that 80% of a first impression is affected by our ability to make and maintain eye contact. When you use eye contact with your audience you’ll get important feedback about how your message is being received.

5. Our vocal delivery is important in face-to-face communication. Don’t worry about modifying a regional accent, but work on speaking clearly and with enthusiasm. Experiment with volume and speed. You’ll know if you’re too loud or too fast by paying close attention to your listener. Watch their body language for clues on how well you are communicating.

6. Even experienced speakers acknowledge that they get stage fright. They welcome this inevitable anxiety and use it to create more energy in their presentations. A few tips for controlling nervousness: hydrate before presentations and keep water near when speaking, focus on having a strong start, use deep breathing and pauses and avoid thinking about the outcome. Treat the presentation like a conversation with good friends.

May 5th, 2009

Posted by
Sara Marberry

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Ian Morrison on Technology

Healthcare author and futurist Ian Morrison is one of the keynote speakers at the X3 Summit in San Francisco next month. I asked him how he thinks technology can be used to make the biggest difference for patient outcomes and what the implications are for building design. Here are his thoughts:

Technology — information technology in particular — is an enabler and an amplifier. The first, real payoff from information technology is in the redesign of care processes to improve performance including safety, cost-effectiveness, and patient outcome. For example, Kaiserâ€™s multi billion dollar HIT deployment has enabled it to experiment with new care processes.

In particular, they have developed disease registries of co-morbid patients, usually those with two or more co-morbidities such as heart disease and diabetes. These patients are identified by the system every time they interact with Kaiser and rigorous checks of care pathways are made to ensure full compliance with care protocols. Early indications are that the number of hospital admissions for these patients can be reduced by 30% or more and the outcomes for the patients are improved considerably.

Thatâ€™s good for Kaiser maybe not so good for a fee for service oriented health system. And, it raises questions about the future demand for hospital beds and the design of our healthcare institutions. If we really had effective care systems enabled by HIT we should we be changing the built environment of healthcare (and our homes) to reflect the new systems of care.

A second key opportunity is in the acute care setting itself, because many people will inevitably need hospitalization, despite our best efforts at primary care and prevention. The combination of new clinical technology and information technology creates tremendous opportunity to redesign work processes and the physical spaces to support them. Many healthcare providers, such as the Mayo Clinic, are using Lean Manufacturing Techniques to re-design the technological and physical layout of patient care and ancillary support areas to optimize safety, reliability, to minimize waste and improve throughput in areas as diverse as ICUs and clinical laboratories.

A third key opportunity that technology represents is to enhance the patient experience of healthcare. Patients are hyper-connected in their normal lives and new technologies can enable support, connection, and continuity in the management of illness, care and recovery. Hospitals are often technology dead zones, where patients and families lose connectivity.

Enlightened providers are finding ways to incorporate consumer facing IT to enhance the environment of care. Obviously, there are some design challenges — building consumerâ€“facing wireless infrastructure in buildings with massive magnetic fields can be problematic, for example. Similarly, there are real infection control issues with keyboards and remotes shared by patients, staff, and family members. Nevertheless, we need to design our hospitals and healthcare environments to make our information technology infrastructure consumer-friendly.

May 4th, 2009

Posted by
Sara Marberry

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Designing the Electronic Hospital

Last week, I asked Cheryl Herbert, President of Dublin Methodist Hospital what kinds of design challenges she ran into, if any, in incorporating electronic health record systems into her new hospital. Did any other types of technology require special design considerations? This is her answer:

Probably the biggest design consideration in our very electronic world was making sure we had enough space everywhere in the building for all the computers, handhelds, and other technology we use. This included space for the computers themselves, plus in some areas, extra batteries for laptops. We also had to plan for a couple of printers in terms of space. Obviously, we had to have enough electric to plug everything in….that’s a lot of electric plugs!

In addition, we had to saturate the building with wireless access points to support the wireless networks, our wireless communication system, our wireless IV pumps, our wireless EKG machines, etc.

The biggest challenge in implementing an electronic medical record was the process redesign. Can’t just take the ‘manual’ processes and make them electronic…have to re-do them. We spent lots of time in this work. That work did lead to some design changes, albeit small ones, but we found details in the design that needed to be revised to match the processes that were designed to work in the electronic world.

(If you’re interested in learning more and contributing to the discussion about the intersection of technology, design, and patient care, check out the X-3 Summit in San Francisco in June.)

Take a virtual tour of Dublin.

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The Center for Health Design Blog

Book Review: “Evidence-Based Healthcare Design”

Access to Capital Through HUD

Tips for Winning a Design Award

Intersection of EBD and EED

Most Influential People

Communication Tips

Ian Morrison on Technology

Designing the Electronic Hospital

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