INTUITION, RESEARCH AND TOMORROW'S HEALTHCARE (audio)
November 18, 2011 – What does mountain biking have to do with tomorrow’s hospital design?
To John Kouletsis, AIA, it’s intuitive. “You have to think of the healthcare institution as a piece of infrastructure that really represents community health,” he suggests, “which means that we take accountability for our patients’ health from, probably even the smallest things in the home or the work setting, all the way up to the point where they might be admitted to a specialty care facility.”
Tomorrow’s healthcare facility is shaped by the confluence of increasingly complex external pressures. Energy costs, decentralized populations, greying demographics, technological revolutions, economic burdens of diagnostic tests and pharmaceuticals, and changing workforce attitudes are pushing traditional healthcare facility models to the periphery. The traditional hospital, for example, was a large, energy-inefficient, complex destination for the sick. The contemporary healthcare facility—the one that can make the connection between mountain biking, riding trails or farmers markets and health, championed by Kaiser Permanente and others—is instead a vehicle to integrate healthful practices into the community. Tomorrow’s healthcare facility is aspirational, evidence-based and focused on community health.
“The span of the design team needs to be quite inclusive and broad,” says Kouletsis, who serves as vice president of facilities planning at Kaiser Permanente. “The extended team might not just involve consultants, designers, ergonomists, nurses and doctors, and patients. It might reach out to environmental services workers. It might include security workers.” What the design team behind the healthcare facilities of the future must have, though, is an owner who’s willing to connect health to design, and an architect who is willing to challenge the status quo.
In the accompanying audio, John Kouletsis poses the question: “If our architects told us that the model of how we delivered health care was no longer applicable, or needed to be revised, would we be willing to listen?” He explains how research, the expanded scope of owner/architect, and sustaining health are critical to the health care of tomorrow. These measures can be readily explored using the framework for a healthful paradigm established at the 7th World Congress on Design and Health.
EVIDENCE-BASED DESIGN: METRICS
Kouletsis has tackled evidence-based design from multiple perspectives during his career. As a Bay Area healthcare architect, he learned to identify research supportive of the client’s business, economic, and performance drivers. As an owner’s representative for Kaiser Permanente, which completes dozens of major projects and thousands of smaller projects each year, he developed an “applied research” approach rooted in intuition; and as an Evidence-based Design Accreditation and Certification (EDAC)-certified individual, he recognizes the value rigorous, academic research can have on both an individual project and the larger profession.
Simultaneously intuitive and well-researched, Kouletsis’s personal two-part model of evidence-based design is characteristic of the profession in general, one which has struggled to dedicate the time, resources or metrics required of academic research. “Some organizations like The Center for Health Design and their Pebble Projects have done a remarkable job elevating more of an academic research attitude into actual projects, and making it work,” but most architects are culling intuitively from their own experiences or the experiences of their colleagues. If a design solution can pass an interim elementary principle—“do no harm”—it might not be a bad thing to apply while the profession develops the evidence to actually support the decision. Adds Kouletsis, “It’s okay to fail, but you need to learn from the failures.”
EXPANDED SCOPE: BUSINESS/PATIENT/DESIGNER
On a project implementing evidence-based design considerations, either academically or applied, architects need to ask, “What are the fundamental issues we’re trying to solve?” says Kouletsis. “Because that will help later in the process to show what kind of evidence needs to be collected and how it should be collected.” Often, architects may find the problems they think they’re solving are either not the primary objective of the client, or they don’t adequately explore the intricacies and subtleties of what the problem might actually be.
All designers bring great experience, problem-solving skills and knowledge to a project, but in the changing face of healthcare and emergence of health-design, the exceptional architect will engage owners, patients, community, pharmacists, doctors, security workers and many more diverse voices to robustly identify issues related to a project. Part of the role of the architect is to be a convener for these voices and to objectively investigate myriad complex issues beyond health, business objectives, economic strategies and environmental priorities of the client and community to affect the scope and measures of the project. Says Kouletsis, “It still revolves around how do you define yourself; how do you define the services you’re bringing to the table; and, can you get an owner to let you into the room, and then engage you in some of those early discussions?”
“If you look at healthcare as an industry today, the portrait across the industry is very complex and not always very optimistic. It’s an industry that’s in a great deal of turmoil, a great many changes are happening. Some negative, but a lot of it extremely positive. And we’re having to rethink the business to make it affordable and accessible,” says Kouletsis. “That is a role the architect could play a major role in.”
Healthcare organizations aren’t design and facilities companies, but they are important partners for architects, who see the world in systems. Providers need architects’ keen insight into how people live—or aspire to live—to realize lofty goals of community health. As practitioners emancipate themselves from long hours in sterile hospitals and patients engage in personal health, an increased amount of healthcare will be issued outside traditional facilities. The entire built environment, through the vision and insight of architects, can engender healthfulness and well-being. Whether it’s through riding trails, green spaces, education centers, well-placed windows, expressive facades, or emphasizing health, locally grown food in isolated communities, no healthcare organization can realize tomorrow’s healthcare today, without architects.
“And I think you’ve got to be open to that,” says Kouletsis, “because architects are going to see things we don’t see. They’re going to see things in other industries that are certainly applicable to healthcare, if healthcare is to become a vibrant, healthy part of the economy.”
In an accompanying podcast, John Kouletsis, AIA, discusses from an owner’s perspective how innovations in evidence-based design are transforming both healthcare and health-design. The podcast is available here. Additional resources and articles can be found at www.aia.org/cvd/