SEPTEMBER 19-21, 2023
Charlotte Convention Center - Charlotte, NC

Author: Sandy Fazaa

Reunited and it feels so good

In January of 2020, the advisory board met like it has at the beginning of the year in Chicago for the past 15 years. The subject of COVID came up a couple of times and there was a news alert that the first case had been verified in Chicago at the time we were there. We all left, said we’ll see you in May in Boston as that is our second board meeting each year, and never imagined we’d go so long between seeing each other in person. As a group we meet twice a year but outside of those settings between the annual HFSE event and other industry events groups of us can be together as many as 5 or 6 times a year. This past December a lot of us were in Austin but not everyone as some folk’s organizations were still not traveling or people had personal situations where they were still not being around large groups.

The Friday before last, over two years later, twenty-eight of us once again gathered in Chicago. The energy was palpable. The friendly banter and teasing felt so familiar. The enthusiasm and passion for our industry and what comes next after all we’ve been through was inspiring. That may have been the most amazing part of it all. We all know what healthcare organizations and the partners that support them have been through. Nobody has been untouched or unchanged. Everyone talked about right now facing staffing and supply shortages and figuring out how to still provide healthcare. And yet there was optimism in the room. There was hope and determination to continue to figure out how to fix some of our most pressing issues from climate change to mental health to reaching underserved communities. Each person contributing in their own way. Intelligent discussions happening and you could see what one person said would spur another to scribble something down or type up a note which often was an email or text to me with an expanded thought on something we’d discussed.

Let me go back for a second to the friendly banter and teasing that was the true delight of the day. These people who enjoy each other’s company coming together and catching up after such a long hiatus. Hearing stories of kids that it seems just yesterday were learning to walk now learning to drive; announcements of new grandchildren, engagements, and graduations; funny anecdotes of what we all learned during the pandemic and so much more. As professionally accomplished as our board is and as varied the backgrounds, what always strikes me about the group is how much everyone enjoys each other’s company and comradery.

It was a special day. And it gave us a lot of great ideas for this September’s event in Long Beach. Stay tuned next week as we’ll be announcing our conference program.

Be well,
Jenabeth

Jenabeth Ferguson
Vice President, Symposium Director

Healthcare Facilities Symposium & Expo

PS. Have a question or comment, please feel free to reach out to me at [email protected]

Design through stories: Experience-based design in pediatric healthcare

By Laurena Clark, Tim Eastwood, and Natalie Petricca

A story can mean so much. Hearing about the experiences of patients and family members can affect us deeply, injecting us with focus and propelling us forward as we design with a particular end user in mind.

Experience-based design is more than just understanding the clinical flow or asking patients for input on design decisions. It’s looking at the experience of an event. It’s hearing the stories that patients carry with them, and the impact of their experience on all five senses. While it’s important to design a functional healthcare space, it’s also vital to maintain a human touch. How can you combine function and experience? Patient experiences are sensitive and personal, so how do you gather and apply these experiences of patients and their families to design spaces that improve experiences?

 

We’ll share some lessons learned from a rewarding project in our hometown of Toronto, Ontario. Adopting an experience-based design approach to healthcare design – especially on pediatric projects – can have a big impact on the healthcare experience.

Blood and marrow transplant/cellular therapy unit

We incorporated experience-based design while working on the redesign of the blood and marrow transplant/cellular therapy (BMT/CT) unit at The Hospital for Sick Children (SickKids), which provides care for patients from across Ontario and Canada’s Atlantic provinces.

This unit is home to some of SickKids’ most vulnerable patients, who stay in isolation rooms for weeks to months at a time and require stringent infection control measures because of their compromised immune systems. In the unit, children can receive treatment for leukemia, lymphoma, aplastic anemia, sickle cell disease, and other conditions.

Staff on the BMT/CT unit have delivered care in the current space for 25 years. Patient rooms are small and require upgrades to support new technology, individual washrooms, physical therapy, and comfort for patients and their families.

During the beginning stages of our redesign of the unit, which took place prior to the COVID-19 pandemic, we had the opportunity to use one larger patient room as a prototype. We used the room to sample different technologies and materials, and enabled care teams to think about how they might work in the new space.

This project gave us the opportunity to engage with end users – children, youth, and their families – which provided a key element of the design process. The experience of patients or caregivers in this type of environment is critical because the extended hospitalization allows people to think about how they might change the space. We knew we needed to hear their perspectives.

Engagement: Learning about experiences

When it comes to experience-based design in pediatric healthcare environments, you need to approach the engagement process carefully. Aside from being empathetic – especially when working with current patients and their families – here are some ideas to consider, taken from our work on the BMT/CT unit:

  • Journey mapping: Can you learn about milestones before the engagement starts? Before meeting with users, we asked care team members about the major milestones of a patient’s experience, from arrival to discharge. This provided us with a structure for our interviews with users, where we could later walk through a patient’s journey. Then, we placed posters on the wall with five different steps in a patient’s journey, asking questions like, “What was the experience like? What would you wish was different about the experience? What were positives and negatives about the experience?” Patients and families wrote their experiences on sticky notes and attached them to posters.
  • Preparation: Before you begin your sessions, make sure you have materials ready for people to describe their patient journeys. Bring samples so users can pick their favorite tiles or floor materials. Provide paper and drawing tools for users to illustrate what their experience was like or to sketch out an ideal room design. For some children and youth in our SickKids session, we asked how they’d design a new patient bedroom for the next patient that needed treatment.
  • Dual format: It’s useful to conduct interviews via a dual format, where you book appointments with some people but also provide an open, drop-in session. This provides a hybrid of structured and unstructured engagement and gives options.
  • An invitation to share: You may not even need to ask many questions during an engagement session – it’s more about inviting people to share their experiences in an informal way. Be prepared for some emotional moments. While working on the project, it touched us to hear some of the sacrifices that caregivers made for their children, including caregivers that slept over for months or traded shifts with their partners so they could maintain their jobs while their children were in hospital. Caregivers told us they didn’t want to leave their child’s room because they didn’t want to miss important information from a doctor.

From stories to design details

After conducting your engagement, you can look at ways to enhance your design with the feedback you have received. Dive deep and immerse yourself in that experience. Imagine every possible way you can make the experience better for patients and the family members (whose wellbeing is so important, given the important role they play in the care of their child).

For example, rather than just painting a wall, could you add a marker board for children and youth to doodle during their stay? Your design decisions can help create something more than a space of healing.

A well-rounded process

In pediatric healthcare, an experience-based approach to your design can lead to a well-rounded process that reflects the unique needs of young patients and their families. We’re driven by the balance between leaning on our technical knowledge and incorporating stories we hear from families. While working on the BMT/CT unit, we always put ourselves in the position of the people we were designing for – such as the child and caregiver staying in the hospital for weeks.

When projects like these, it’s all about listening. And the more you listen, the better you design.

Happy Reading

By Jenabeth Ferguson

Friday is our call for speaker’s deadline. This is the time of year when folks from all over, representing many different interests in our industry, submit a proposal for a chance to be part of the conference program. Hundreds will try for a speaking slot but we don’t have room for them all, so hard decisions will be made. This also happens to be my most favourite part of planning the Symposium each year.

The process is a cumbersome one and requires a lot of effort from members of our advisory board and me. A committee of anywhere from 10 to 15 board members read all the submissions. And then they begin to rate them on content as a stand-alone, then compared to other submissions on the same topic, and sometimes up against other submissions from the same firm. The rating systems are not all the same; some score them from 1 to 5, others categorize them as yes/no/maybe and others give feedback in narrative form. They have a month to do this because it takes a long time to read them and truly digest all the effort everyone has put into submitting. At the same time, I am reading them too. At first, I read them without making any comments or judgement, absorbing and taking it all in. Then, I start to make comments in the margins. And yes, this is the one time of year I am old school and I print out all the proposals and carry them around like a teacher grading papers. Finally, I will start to make tallies of similar subjects, multiple submissions from same person and/or firm, types of organizations and their geographic location. This is also when I see holes in terms of topics and/or projects we wanted to cover and I go back out to experts and get them involved to fill in the gaps.

The fun really begins when I receive all the committee members’ comments. It’s just like every judging contest you see on TV nowadays in that there are very few instances where everyone agrees! Sometimes I find it comical and other times it makes the final decision so much harder. You also have to take their biases into account, for example, are they an architect and the topic is too technical, but an engineer would find value. Or are they farther along in their career and find it too basic, but an emerging leader would be interested. It’s my job to remember all of that. It’s also my job to keep track of topics, health systems of various sizes, geographic location of presenting organizations as well as making sure the same organization is not presenting on more than one panel and that every case study must have a representative from the healthcare provider co-presenting.

I do all of that over the course of a several of days with piles of proposals spread out on every surface, post it notes to help keep me organized and legal pads of lists. It’s messy and creative and hard and so much fun! Committee members get emails, texts and phone calls soliciting their counsel or clarification on what they thought. I sweat each decision. I have a series of checks and re-checks to ensure all our priorities for that year are met. And at the end we have what is hopefully a well-rounded conference program that has something for everyone and will educate and inspire our attendees.

In 2020, we did this exercise in the very early days of the pandemic when we were all in lockdown. Frankly, as I went through the process, it was not very far from my mind that it may very well be an exercise in futility which of course it was, as we never held an event that year. The program was technically put together, we’d accepted the final presentations and then we kept putting off posting it through the month of May until we officially cancelled our 2020 event. Last year again I went through the exercise and while I was hopeful, we’d have an event there was still a feeling of uncertainty. In the end that program was pushed from September to December and looked a lot different by the time we got to Austin, but a good number of sessions carried all the way through.

I am about to begin my annual ritual of reading proposals and carrying those piles with me for the next month. Going through them any chance I get, and I cannot wait! For the first time in 3 years, I will get to do this with the joy I have always felt reading everyone’s ideas and starting to think about how the pieces fit together and talking to board members to hear their views and taking all the important factors into consideration to come up with the best program we can for this September in Long Beach.

If I don’t respond to email as quickly as usual in the next month or answer my phone as fast, know that I’m somewhere in a corner with a highlighter reading speaking proposals and so happy.

Be well,
Jenabeth

Jenabeth Ferguson
Vice President, Symposium Director

Healthcare Facilities Symposium & Expo

PS. Have a question or comment, please feel free to reach out to me at [email protected]

We’re Back!

By Jenabeth Ferguson

Two weeks ago, I stood on the stage in Austin and addressed the Symposium community in person for the first time in over two years. It was pretty amazing to look out at all those people who had trusted us enough to come back out and take part in in-person events once again.

There were so many highlights! Watching friends and colleagues who had not seen each other for some time come together again. Listening to speakers share lessons learned to folks sitting in the room. Seeing exhibitors show their products to people with the ability to touch and feel. Hearing Bruce Komiske talk about his experiences building hospitals through philanthropy. Feeling the buzz of people networking at the Happy Hour.

My favorite might have been our opening keynote, Alan Graham the Founder and CEO of Mobile Loaves & Fishes (MLF). Alan is the visionary behind MLF’s Community First! Village — a 27-acre master planned development that provides affordable, permanent housing and a supporting community to the chronically homeless in Central Texas. It was pretty remarkable to hear but even more awe inspiring to see in person. On Wednesday afternoon, when the event had ended, two of our board members and I went out to Community First and toured the village.

It was one of the quietest, cleanest, most beautiful neighborhoods I have ever seen. It’s a village of tiny homes mostly with community kitchens, gardens, a library, a health clinic, art studios, marketplace, chapel, store, auto shop and outdoor theatre. The neighbors all have the opportunity to earn a dignified income at all those places. It is a remarkable place. I know we were not the only ones from the Symposium who took time to go out and take advantage of a tour. My wish is for all those who heard Alan and especially those who toured are inspired and motivated to create similar neighborhoods across America.

Happy Holidays and a Healthy New Year to you and yours!

Be well,
Jenabeth

Jenabeth Ferguson
Vice President, Symposium Director
Healthcare Facilities Symposium & Expo

PS. We’re heading to Long Beach, California in 2022 – September 27-29. Save the date!

EvaClean unveils PureExcellence for True Infection Prevention Partnerships

Braintree, MASeptember 2021 – The vision for proactive infection prevention has been realized in the EvaClean solution with proven processes and safer, more effective cleaning technologies. Over time, EvaClean has also become a trusted advisor for infection prevention units and environmental service teams in hospitals, health systems and long-term care facilities, as well as in colleges and universities. Ultimately, the unique needs of these industry sectors inspired EvaClean to create PurExcellence.

EvaClean’s PurExcellence is a progressive program built on six key pillars—Assessment, Standardization, Education, Safety, Sustainability and Guaranteed Cost Savings—which establish a roadmap to true infection prevention partnerships with healthcare and higher education.

The first step in the quest for PurExcellence entails a complete site assessment of current protocols, chemistries and applications based on a number of factors specific to each facility.

Kurt Wong, Chief Experience Officer at EarthSafe, EvaClean’s parent company said, “The data is used to develop a comprehensive chemical analysis, then compared against a more standardized approach using safer chemistries, which invariably yields cost savings of at least 30%.”

However, these benefits can’t be realized without ongoing targeted education that ensures proper procedures are implemented on a consistent basis.

“One of the most critical components of PurExcellence is customized training for the life of the partnership,” said Rich Prinz, Senior Vice President of Sales. “Perennial education helps ensure higher levels of safety, compliance and productivity to achieve better outcomes.”

Safety has always been one of EvaClean’s primary pillars. That’s why PurExcellence is standardized around EvaClean’s PurOne®NaDCC cleaner and disinfectant. Not only does PurOne have the first EPA registered biofilm bacteria kill claim, it also eradicates over 55 organisms on 12 EPA lists, including multi-drug resistant and emerging pathogens. To mitigate cross-contamination, PurOne can also be used with EvaClean’s disposable environmental surface wipes or, alternatively, the wipes system can be used to augment existing programs.

Yet, high level efficacy is only half the safety equation. In addition to protecting patients, students and staff, solutions must also protect the environment. EvaClean’s advanced chemistries are HMIS rated 0/0/0 with a neutral pH, as well as biodegradable and fully OSHA, NIOSH and JCAHO compliant.

CEO Steve Wilson said, “Long-term sustainability is another important aspect of PurExcellence. Our technologies were specifically designed to deliver both environmental and economic benefits.”

Because PurOne and PurTabs®, EvaClean’s electrostatic sprayer disinfectant, dilute to different strengths for multi-purpose solutions and are highly effective at lower parts per million (ppm), it takes less chemical to accomplish more. The tablet format also requires less packaging, translating to less shipping, emissions and environmental impact. When strategies include electrostatic disinfection of all touchpoints, chemical consumption is even further reduced.

The six pillars of EvaClean’s PurExcellence initiative are a proactive formula for the prevention of infectious outbreaks and HAIs, which adds up to higher quality care and lower associated costs of at least 30%–guaranteed.


About EvaClean

Originally developed by EarthSafe Chemical Alternatives® in 2016, EvaClean® has become the preeminent infection prevention solution. In addition to a portfolio of advanced electrostatic technologies and safer, more sustainable chemistries, EvaClean provides customized protocols and ongoing training to simplify processes and improve outcomes. Founder and serial entrepreneur RJ Valentine, together with an exceptional leadership team, have built EvaClean into one of the leading authorities on healthier disinfection across all industry sectors. Learn more at www.evaclean.comand follow us on LinkedIn, Facebook and Twitter.

PRODUCT INNOVATION, DESIGN EXELLENCE AND INDIVIDUALS HONORED AT HEALTHCARE FACILITIES SYMPOSIUM

Jenabeth Ferguson
(203) 307-2696
[email protected]

Healthcare Facilities Symposium & Expo announces 2021 Symposium Distinction Awards

The 2021 Symposium Distinction Award Winners were honored at the annual Healthcare Facilities Symposium & Expo at the Austin Convention Center in Austin. The Awards program recognizes design teams, projects and individuals who have made a profound contribution to the healthcare design industry. The program accepts submissions of all types and sizes of patient care-related facilities. In addition it recognizes the best and most innovative new products within the healthcare design & construction industry. Medical Construction & Designsponsors the Symposium Distinction Awards.

The 2021 Symposium Distinction Award Winners are:

PRODUCT AWARDS
MOST INNOVATIVE
Spatio Metrics

Spatio Metrics is a software product that gives healthcare designers the data they need to champion design for outcomes.

Decades of research has shown how the built environment affects healthcare operations and the patient experience. But many facility design teams don’t have the data they need to champion design decisions, especially when it comes to proven qualitative concepts like natural light, nurse supervision, or patient privacy. Many powerful design interventions end up getting value engineered out of projects because designers don’t have the data, or the business case, to show how it can benefit the project’s bottom line.

For more information visit www.spatiometrics.com/healthcare

MOST SUSTAINABLE and ARCHITECTS CHOICE
Vaask

Vaask is the only hand sanitizer fixture purposefully designed for modern interiors and features robust all-metal construction, real finishes of bronze and stainless steel, and high-capacity cartridges built to last. Inspired by the Norwegian word for “wash,” Vaask embodies clean lines and clean hands, ensuring you’ll never again compromise between form and function.

For more information visit https://www.vaask.com/

DESIGN AWARDS
USER CENTERED AWARD
Nationwide Children’s Hospital, Big Lots Behavioral Health Pavilion submitted by NBBJ

Nationwide Children’s Behavioral Health Pavilion is unprecedented, creating a transformative model for pediatric behavioral health facilities across the United States. Challenges became opportunities, and the design process provided a unique avenue to redefine what a pediatric behavioral health center could be.

  • Designing for a unique patient population. As the pediatric behavioral health population is a sensitive population — the team was unable to communicate with them openly one-on-one about their needs — they relied on extensive data and research to design for them.
  • Creating indoor-outdoor connections. The project provides unprecedented outdoor spaces in a 10-story urban behavioral health facility that are safe and welcoming for patients, loved ones and staff. Yet through a rigorous design process, testing and feedback, the team created uplifting spaces that offer respite and connection to nature that are unlike any other facility.

For more information visit http://www.nbbj.com/work/nationwide-childrens-hospital-big-lots-behavioral-health-pavilion/

TEAM AWARD
U.S. Department of Veterans Affairs, Omaha VA Ambulatory Care Center submitted by LEO A DALY

The VA’s first-ever public-private partnership (P3) revolutionizes veteran healthcare, providing a state-of-the-art medical home for veterans and a powerful unifying gesture to the larger Omaha VA community.

After the 1950-built Omaha VA Medical Center was passed over for scheduled replacement in 2010, a group of concerned citizens petitioned Congress to pass the CHIP-IN for Veterans Act. This law provided a legal avenue for $30 million of locally raised donations to be combined with $56 million of previously allocated federal funds to design and build a new clinic building. As a result of this arrangement, the design and construction team employed a collaborative project delivery method (CM-at-Risk) and were given considerable flexibility in adapting the VA’s design guidelines to project-specific criteria. The result is a landmark project, designed and built in just over half the time of comparable VA projects, and for $35 million less.

For more information visit https://leoadaly.com/our-work/markets/healthcare/

ADAPTIVE REUSE AWARD
Pediatric Outpatient Center at Children’s National Research and Innovation Campus submitted by Array Architects

Formerly a military tuberculosis hospital as the site of the historic Walter Reed Army Medical Center, Building 52 of Children’s National Research and Innovation Campus has been transformed into 24 exams rooms, staff support space, and co-located with the main research building. The building is one part of the health system’s one-of-a-kind pediatric research and innovation hub.

The interior of the building was fully renovated, and the main structure of the building and brick elements remained throughout. On the exterior, some of the building’s newly constructed elements are designed to mirror the original design, including woodwork, glazing, and roofing. On the south façade, the tripartite windows were in disrepair and needed to be replaced in-kind. The sleeping porches were reclaimed as conditioned interior to help fulfill the programmatic requirements associated with a 24-exam room facility. To maintain a similar aesthetic to when the sleeping porches existed, the team enclosed them with full height curtain wall glazing, with black frames to recede into the background. The design employed strategies throughout to maintain openness, playfulness, and comfort. Keen attention was given to materials to ensure the durable and cleanable nature required for a clinical space, while being mindful of pairing them with materials that will help the overall patient and staff experience.

For more information visit https://array-architects.com/projects/building-52/

GEORGE PRESSLER UNDER 40 AWARD
Josh Domingo with HDR

In the 16 years that Josh has been in the industry, he has worked tirelessly to expand his knowledge of designing healthcare facilities. His experience ranges from small community hospitals to large international facilities, yet he doesn’t let the size and scope of a project change how he approaches a problem. Josh is constantly looking for ways to create world-class facilities by studying and researching the latest design trends and innovations to deliver a product to his clients that not only serves as a healing environment for their patients, but also is a place that family members and staff can thrive as well. With a master’s degree in architecture from Clemson University’s Architecture + Health program, Josh’s career trajectory has seen him solely focused on health planning while bringing his in-depth knowledge of the healthcare industry and all-around understanding of architecture together to significantly provide the expertise needed to create truly healing environments.

Over the years, Josh has grown into a role that has him at the forefront of the design and planning of each of the projects that he’s involved. Utilizing his prior knowledge and data he’s garnered through researching latest trends, Josh’s ability to engage clinical users to ensure the right design decisions are made is just one of the characteristics that make Josh a successful designer and invaluable member of any team, which is why he was recently elevated to Senior Health Planner and Professional Associate. Because of his devotion to his craft and his eagerness to continue learning, Josh has become one of the most utilized and in-demand healthcare architects when it comes to designing hospitals for the future.

INDIVIDUAL AWARD
Victoria Navarro with Advocate Aurora Health

Victoria Navarro is a Regional Director in the Planning, Design and Construction Department at Advocate Aurora Health (AAH). Advocate Aurora Health is the 10th largest integrated not-for-profit health system in the United States serving communities across Illinois and Wisconsin. She has a Master of Business Administration in Healthcare Management from Loyola University Chicago and a Bachelor of Architecture from the Illinois Institute of Technology.

Victoria provides strategic direction and oversight to both system-wide and regional based capital construction projects including the management of healthcare facilities and corporate real estate portfolio. During the past 20+ years, Victoria has served as senior healthcare planner for national architectural firms. She provides the highest-level planning and design expertise to healthcare clients, guiding organizations to improved performance by applying lean processes and leading through Integrated Project Delivery (IPD).

She has delivered more than $1 billion in forward focused capital projects in the last 20 years, leading teams to analyze and solve complex challenges and achieve successful enterprise-level improvements. As a key team leader on the first LEED Healthcare Gold Certified hospital project in the Midwest, Victoria implemented standardized facility operations and room design, utilized modular and prefabricated construction, and the Integrated Project Delivery method. She has led multiple IPD teams using master service agreements that established shared risk and reward incentives with preferred providers.

The Distinction Award Winners represent a diversity of talent, creativity, innovation and passion to create healing healthcare environments, chosen by an elite panel of industry executives including:

James Atkinson
Vice President and Director, Healthcare Design and Planning
HDR, Inc

Marcus A. Budaus, AIA, ACHA, LEED® AP
Principal / Senior Vice President
HKS, INC.

Gary W. Collins, AIA, NCARB
Virtual Energy Solutions

Amy Douma, AIA, NCARB, and LEED AP
Vice President
HGA Architects and Engineers

For more information on the Symposium Distinction Awards, visit hcarefacilities.com/awards/.

More Information / Show Updates:
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Back to In Person Events

By Jenabeth Ferguson

Two weeks ago, Ann and I attended an event at the Boston Convention & Exposition Center. It was the first time in almost two years I stepped foot on an exhibition floor and for someone who has been in the conference and tradeshow industry for almost 25 years, it was by far the longest I had gone not being in that setting. A lot of things looked far different from the last time I’d been at an event.

Part of the pre-registration process included showing proof of COVID vaccination or a negative test within 72 hours of attending. Masks were required per the city of Boston. There were a lot more hand sanitizer stations everywhere. You could choose your badge holder by color to indicate your comfort level of contact with other attendees. The seats in session rooms were spaced apart. There were one-way signs for the aisles in the exhibit hall. All those things were new and different due to COVID but what wasn’t different was the networking and engagement of those in attendance.

People were inspired by the keynotes. Speakers were sharing their expertise and lessons learned in the conference sessions. Exhibitors were demonstrating their latest products and services. And perhaps most importantly, old friends and colleagues got to see each other in person and not through a screen.

It was a good thing for me to see as we get closer and closer to bringing the Symposium community back together this December. We will be having a lot of the same precautions in Austin which you can read about here. I know some of you may still not be comfortable or able to join us and that is certainly understandable. And others I keep hearing from quite literally cannot wait to walk back into the Austin Convention Center and see so many of your friends and colleagues from all across the country together again.

If you are planning to be in Austin this December or if you are still considering registering and have any questions, please feel free to reach out to me.

Be well,
Jenabeth

Jenabeth Ferguson
Vice President, Symposium Director

Healthcare Facilities Symposium & Expo

Progressing Beyond the Rubicon

By Dr. Wayne Ruga, FAIA, FIIDA, Hon. FASID

This article is about the future – yours, mine, and everyone’s. It is a ‘call’ to courageous progress.

Background: The expression, ‘crossing the Rubicon’, is meant to evoke a decision to a significant course of action – an irrevocable action where there is no going back, as in 49 BC, when Julius Caesar crossed the Rubicon River and the events leading to the rise of the Roman Empire unfolded. In the 1970s, Thomas Kuhn developed the concept of a ‘paradigm shift’, with a similar meaning. Today, it is common to hear the expression, ‘let’s get out of the box’, a metaphor meaning much the same. In all three of these cases, radical progress is harkened – a systemic improvement over the status quo – one that requires courage to advance into the ‘beyond’.

At the 2017 30th annual Symposium, in Austin, we commemorated this milestone event by drawing upon the image and legend of Janus – the Roman god of transitions. The image portrays Janus as a left and a right profile – with a straight-on portrait between these two profiles – to mean that, as we progress into the future, we should inform our journey with learnings from the past. At the 30th Symposium, as we discussed progressing into a future informed by learnings from the past, none of us could have imagined the arrival of the Pandemic on our doorstep, about to challenge everything we thought we knew.

Foreground: As we make our preparations to return to Austin for this year’s 2021 Symposium – having completely skipped a Symposium for the first, and only, time in the history of the event – to be certain, during the last 20 months, we have all been required to cross the Rubicon, shift numerous paradigms, and get ourselves out of many a box. In my roles as the Symposium founder, healthcare and design innovator, pioneer of new futures, and teacher, I am frequently asked to comment on what we’ve learned through the challenges of this pandemic that will have a lasting, positive impact on how we create our future.

In this regard, the Sankofa – the mythical bird of Ghana – offers useful guidance. It is an inspired legend that reminds us of Janus, with the additional dimension of ‘wisdom’. The native Akan tribe, the source of the Sankofa legend, believe that the past should guide us in how we plan our future – and, that it is the wisdom from this learning that enables us to make a stronger future likely. In the tradition of Socrates – I turn the question to you: what have you learned during these 20 months, what wisdom have you gained, and how will this wisdom inform the decisions you will make as you progress into the new future?

My own view on this question – what have we learned – has multiple dimensions: (1) how can the Symposium impact the new future; (2) what impact can I (the collective ‘I’) possibly have on the new future; and (3) how can ‘I’ contribute – positively – toward creating a new, and better, future? How each one of us addresses these dimensions is profoundly crucial, in terms of how our collective new future will unfold.

For example: How can the Symposium impact the new future? First-time attendees may get the impression that the Symposium is a conference – although it contains many of the same elements that a conference does, it has so much more to offer. The Symposium can be better understood as a crucible, a vessel where transformation is forged. Each year, radically new ideas are presented and discussed that are carried by the attendees further into the world to advance progress. Whether these ideas exist as information, knowledge, or wisdom – it takes courage to learn new ideas and use them to improve the status quo, as Symposium attendees have done for decades, as inspired and courageous agents of transformation in health and healthcare.

The Symposium, as a crucible, has an established pioneering legacy of fueling the transformation of the individual lives of its attendees by providing direct exposure to: new, and often – very different – ways of thinking; new connections, support, and resources from meeting and engaging with like-minded individuals; and new business opportunities. There is no other healthcare facilities design event that has so profoundly improved lives around the globe, because of this transformative function – the lives of patients, families, staff, and local community residents.

To find ourselves asking, ‘what impact can I possibly have’ is to overlook the many unique opportunities that have opened up because of this unprecedented moment in our history. Every single individual has a significant, unique, contribution to make towards the creation of a new and better future – although it is not always so easy to see that, and to have a clear idea of what we each can do. This is precisely why we must reach into the ‘beyond’ – the beyond the Rubicon, into the new paradigm, and get ourselves out of the box. As Hillel the Elder said. ‘If not now, when? If not you, who?’. Now is the time.

The question: ‘how can I contribute – positively – towards creating a new and better future?’ is not a simple question with a simple answer. It is an inquiry that each one of us has the opportunity – and responsibility – to engage in. Why do I make this bold assertion that we each have the ‘responsibility’ to consider this question? My view is that we are all leaders – some of us are highly visible and recognized leaders, with ‘leader’ written in all capital letters; many more of us are leaders, written simply with a capital ‘l’; and – most importantly – every single one of us is a leader in lower case letters: the leader of an enterprise, called ‘my life’. As the leader of this personal enterprise, we are the CEO, and we have sole leadership responsibility – as the CEO of our life – just as the CEO of a major organization has. In this role, we have the responsibility to discover how our inherent personal, unique, agency can find purchase – and traction – to advance our own enterprise.

Of course, advancing our enterprise does not necessarily mean that we will contribute positively towards creating a new and better future – so, I qualify my comments by drawing upon the words of Reinhold Niebuhr, author of the ‘Serenity Prayer’: ‘God, grant me the serenity to accept the things I cannot change, courage to change the things I can, and wisdom to know the difference’. From this prayer, I highlight the words, ‘courage’ and ‘wisdom’. The Sankofa enabled us to appreciate the value of wisdom in informing our future with learnings from our past – a new understanding that the teachings of Janus were silent on.

‘Courage’, however, is a new aspect – one that the Serenity Prayer contributes to our inquiry: a personal exploration of considering what things can I actually change? In our modern times, definitions and understandings of ‘courage’ have emphasized brave and fearless actions, particularly when faced with adversity. Examining the origins of ‘courage’ provides us with a further understanding – ‘courage’ is derived from the Latin root of ‘cor’: of the heart. When ‘courage’ is used in this original way, it encourages us to discover and to speak openly of truths from our heart, as opposed to brave and fearless actions, which have their origins in our brains.

As we further consider the root of ‘courage’, we must each discover a personal way to understand our heart in a new way – not merely as a mechanical pump for the purpose of circulating blood, but – rather – as the center for our ability to gain access to unique intelligences that – amongst their far-reaching capacities, enables each one of us to pursue courageous self-expression. Neibuhr’s Serenity Prayer invites us to use our ‘wisdom to know the difference’ – a profound opportunity to learn how to clearly distinguish the wilful volition of brain-driven actions, from the more subtle and elusive callings of our hearts, and – as a result – access personal expressions of ‘courage’ that can move mountains and transform futures.

What have we learned? If it isn’t as obvious to you as it is to me – old habits are hard to change, and ‘necessity is the mother of all invention’. It is surprisingly easy – more than we imagined – to try doing old things in new ways, and – presto – the outcomes are improved. What about making a really big stretch, and also discovering how to do new things in new ways?

The September / October 2021 issue of Harvard Magazine has a feature article, ‘The State of the Pandemic: Lessons Learned from the Continuing Confrontation with the Virus’. It discusses a range of lessons learned – some of which call to us to create futures that – heretofore – were unimaginable. For example, the article reminds us that the Pandemic is a global challenge, and we have not yet developed the global structures to adequately withstand future health threats – or the resources. In our current era, the wealthiest countries can have the best outcomes, while our less wealthy relatives have less robust defences – is this the future we really want for our children, and their children?

The article mentions the built environment, and some of the health challenges that our current inventory provides – such as closed and ventilated buildings, and insufficient intensive care capacity for future epidemics. As a community of leaders, with a passionate interest for improving health and healthcare facilities, we can expect that the Symposium will inspire novel remedies to these deficiencies that will contribute towards improving the resilience that we rely on our essential services to have, and to continuously upgrade.

A ‘Call to Courageous Progress’: Pablo Picasso famously said, ‘I am always doing that which I cannot do, in order that I may learn how to do it.’ No doubt, if Picasso was still alive, he would have been a notable Symposium Keynote speaker, and a regular attendee. Although the richness of the distinctly different Symposium attendees is invigorating, Picasso’s quote provides a fascinating snapshot of the key characteristics that weave their way through the global Symposium community – a commitment to regularly and consistently doing the impossible, and continuous learning. And, as a Picasso scholar might explain to us, Picasso’s quest to be ‘always doing that which I cannot do’ was driven by his courage – in translating the wisdom of his heart and learning to create from this source – much as each one of us might do, as we courageously progress on our respective leadership journeys, in creating a new and better future for the many generations to come.

In conclusion, this ‘call’ is a thundering shout: now is the time to draw a line in the sand, beyond which is a new and much better future than our recent past (50 years?). Let’s all discover and draw from our wisdom, learn from our journey, and invest our precious life force into courageous demonstrations of our unique agency – the gifts we were born with, the legacy that our ancestors bequeathed to us, and the dreams that inspire each one of us to leave this world better than when we arrived.

Wayne Ruga can be reached at: [email protected].

On the Rollercoaster Again

By Jenabeth Ferguson

Last week I spent most days at the beach with family we haven’t seen for any real extended visits in over eighteen months. I spent my nights at baseball games with friends cheering on our team. It was long days of up and out of the house early, car packed with change of clothes and snacks, getting home late pouring yourself into bed exhausted, suntanned, and elated. It felt normal, very much like my pre COVID life where the pace is hectic and every minute chocked full.

All the while I was getting messages from board members, speakers and other industry contacts about full ICUs, offices reverting to masks required and no external meetings and travel restrictions being reinstated. Many of you are managing your facilities during this continued public health crisis or helping your clients do the same. I hear the frustration in a lot of your voices and emails. I want to say thank you to all of you who continue to support those healthcare workers on the front lines.

The good news is I am also hearing from a lot of experts that in December things will be better, which is when we look forward to welcoming the Symposium back together again. In September, we will release more definitive information on our health and safety plansfor this year’s Symposium. If you have any questions in the meantime, please feel free to reach out to me.

Be well,
Jenabeth

Jenabeth Ferguson
Vice President, Symposium Director

Healthcare Facilities Symposium & Expo

Rapid Adaptation: Redesigning a VA Senior Living Center to Contend with COVID-19

By Jay Pelton, RA, LEED AP, & Morgan Young

In 2019, the Lebanon, PA Veterans Affairs (VA) Medical Center tapped Miller Remick and Array Architects to design and construct a Community Living Center (CLC) that follows the VA standard small house modelfor their campus. Little did the team know that the pandemic was about to fundamentally change how age-in-place environments are designed. In this article, we’ll review strategies to adapt existing designs to meet new guidelines by exploring how the design team addressed MEP and operational challenges posed by the pandemic.

Project Overview

The existing CLC is located inside the 1940s H-shaped historic nine-story inpatient building on the sprawling campus. Each floor plate was only 30-40’ wide, with the structure and double-loaded corridors limiting each resident room to be no more than about 15’ wide.

Phase one of this project consisted of a full master plan to move their current beds into
small houses to be constructed on campus. This aligns with the guidance of the new small house model, which includes four 14-resident CLCs and one town/community center which will interconnect all residents. During the master plan, the team determined we would need to relocate 56 beds, so the CLCs evolved into four small house models – all connecting to one central town hub through a series of connecting corridors.

The team had completed the CLC’s schematic design when March 2020 arrived. As the pandemic took hold, the VA remained steadfast in protecting their residents with new HVAC solutions in the inpatient hospital. The VA learned a lot at that time, often acknowledging that sealed shut windows were a very difficult obstacle.

Questions and Downstream Implications

The team began their re-evaluation when the building was at 35 percent completion. At this stage, the building was designed with mechanical and available infrastructure efficiency in mind and was equipped with geothermal heat-pumps and a single air handling unit. Working with the VA, Array and Miller Remick looked at what could be done to improve the residents’ outcomes should the pandemic happen again, after the future CLC was occupied.

The first decision was determining how far to take the protection. Would we need to treat each small house separately? Would we need to treat each connected community differently, or address each individual on a case-by-case basis? Would staff need to don and doff equipment differently? How would the normal course of meals and daily resident life be altered? Would they be able to share in the planned small house amenities?

The team first looked at the plan to determine what would create the most versatile solution. We explored how we could prevent airborne virus spread most effectively. The current VA approach to protecting the veterans inside their hospital rooms naturally influenced our thinking. The team considered this approach within the context of the floorplan layout. If we needed to boost our HVAC system, we had to start over, and knew we had to begin with the level of protection necessary to provide residents and staff protection during a pandemic. Our floorplan was a Y-shaped spine and two wings. Each wing contained seven rooms.

Re-assessing Floor Plans

The team looked at the plan for how to limit airflow among all spaces. Originally, there was only one air handling unit (AHU); the building was designed efficiently with geothermal pumps producing a majority of the conditioning with a lower air delivery. The team determined that if there were COVID-positive residents, one AHU will no longer be sufficient because it would make the whole building ‘hot,’ or contaminated. Our design was now at risk and we needed to determine how to revise the HVAC system. But first, we needed to tackle the transmission problems. We established rules for three categories of residents: those who were in contact with COVID, those who were not and those who might have been. In looking at residents who were, the agreement was to limit room air exposure recirculation.

Working with the VA, we developed a series of options. When we compared an isolation room-type scenario to these air delivery needs, it quickly became evident that these rooms needed to be 100-percent exhausted. Along with the design community at large, we learned that contact tracing would not be able to definitively identify the residents with COVID in time for them to properly isolate. Therefore, we needed to treat everyone who went to their own room as if they had COVID. We also needed to designate safe areas for the staff to continue to support residents, both in and out of the hot zones. Very quickly, we decided to limit the access to the resident corridors with closeable doors from the main spine and treat the rest of the rooms as if they were clean.

Determining New Needs

Now that we identified a layout and compartmentalization strategy that accomodates occupants during a pandemic, the next step was to assess the new needs of the mechanical system. We determined that one geothermal-fed unit would not have sufficient capacity for new air requirements because the air changes per hour (ACH) would go from two to a minimum of six per residential room. In order to redesign the system, the team implemented a plan to provide multiple chilled water air handlers, one for each wing’s distribution, plus a 100 percent exhaust system.

Key Takeaways for Updating HVAC in Age-in-Place Environments

Selecting the right HVAC system for age-in-place environments is important to ensure your facility is future ready. Here are five key takeaways from our experience to guide your decision:

  1. Select an HVAC system that provides conditioned air by a Variable Air Volume AHU. By doing so, our team was able to provide the VA a “Pandemic-mode” for the resident wings which prevents recirculated air within the building and meets the minimum six ACH per hour.
  2. Ensure the AHUs are capable of negatively or positively pressurizing each resident’s room to isolate infected patients from the remaining population. In our case, three AHUs – one for the central core/spine, and one each for the two resident wings – were needed.
  3. Specify for versatility. At the CLC, the HVAC system feeding the residents’ rooms will allow for the rooms to be convertible from normal condition, nearly pressure balanced with respect to the adjacent corridor, to a negative pressure condition. This will be accomplished by increasing the air flow of the supply air valve serving each of the resident rooms so that the rooms will go positive relative to the resident bathroom and the adjacent corridor. Additional back-up of natural ventilation can be achieved through operable sashes in the windows.
  4. Adopt advanced air purification equipment. For this project, our team used Genesis Air as a basis of design, which utilizes photocatalytic oxidation to reduce infection and improve the indoor environment in hospitals. Data shows that hospitals with this equipment in critical care areas have a significantly lower MRSA standard infection rate.

In Closing

Rapid adaptation is possible to a design-in-progress for an age-in-place environment like this Veterans Affairs Community Living Center. When retrofitting a facility or modifying a design, weigh how the layout can be reconfigured to safely compartmentalize patients as needed, and identify the most critical planning elements that must be addressed. Working in tandem with a skilled MEP firm, select and specify the right HVAC system, one that allows for negative and positive pressurization, appropriate AHUs, versatility and air purification.

Prior to the publication of this article, the FGI offered draft guidancefor designing resilient healthcare and residential facilities to adapt to emergency conditions, including pandemic response.

Downloade the high-reg images found in this article by clicking here.


About the Authors

Jay Pelton, RA, LEED AP
A Principal and Project Architect at Array, Jay Pelton is passionate about delivering projects that offer sustainability, energy efficiency and environmental harmony. His technical focus ensures a proper coordination between building engineering elements, the established building program, and the aesthetic goals of the institution.

Morgan Young
An Architectural Designer at Array Architects, Morgan Young is inspired by the opportunity to drive positive change in people’s lives through the built environment. His experience includes work with clients across the mid-Atlantic, and he has earned awards and co-edited grant publications rlating to his design savvy and expertise.

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