When Nursing Meets Architecture

Building a Unique Nurse Consultant Role in Healthcare Design

September 5, 2018

Partner, NBBJ

Editor’s Note: This post was originally published on Medscape. It was coauthored by Kristina A. Krail, RN, BSN, MPH, and Teri Oelrich, RN, BSN, MBA.

Nurses as Design Consultants in Architecture

As a nurse, have you ever watched in wonder the marvel of a new hospital rising out of the ground? Are you curious about the history of your campus or building — how it came to be or who created the design? Have you enjoyed serving on a committee when your organization was planning a new building, unit, or renovation? Was there ever a time in your nursing practice when you were frustrated with the design of your work setting and asked yourself, “What were they thinking?”

If you answered “yes” to any of these questions, you may be interested to know about the small but growing group of nurses who work directly with architects, engineers, and construction managers to build or renovate healthcare facilities. Employed as clinical consultants, project managers, planners, data analysts, or group facilitators, these nurses play a vital role at the cornerstone where the design and healthcare industries meet. By representing the various constituents through a keen understanding of the perspectives of each (and the language they use), and by leveraging those effective interpersonal skills honed as healthcare providers, nurses employed in this serve a vital role in all stages of the design process.

This area of specialty is relatively new. In 1989, the architecture firm NBBJ became one of the first to employ full-time nurses after I completed my MBA and responded to a NBBJ job posting for healthcare consulting. Today, I’m a partner in the multimillion dollar company.

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Co-author Kris Krail (at right)

At NBBJ I am joined by, among others, Kris Krail, who came to the firm serendipitously after a long career in nursing administration serving as a chief nursing officer at a variety of hospitals. She was excited to join an architecture firm because her father was a draftsman, she was active in preserving historical buildings, and the most enjoyable times during her administrative practice were when her hospitals were in a building mode.

Although the American Nurses Association does not yet recognize this type of work as its own specialty, it does direct interested professionals to the Nursing Institute for Healthcare Design — a 150-person organization of like-minded professionals with a common goal of integrating clinical expertise into the planning and design of healthcare environments.

The Role of Design Consultant

Nurses in the architecture, engineering, and construction industries must possess leadership qualities, demonstrate emotional intelligence, and be nurse experts in their field of functional or clinical specialty. We work both internally within a project team and externally with healthcare clients, so the ability to collaborate and communicate is paramount, and well-honed writing and public speaking skills are essential. They must also be comfortable and self-assured enough to interact with all client levels of personnel, from entry-level service staff to physicians and board members. An advanced degree may be required, but more important is the ability to demonstrate astute organizational skills and manage projects in a self-directed way.

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Co-author Teri Oelrich (at left)

The work itself and the benefits derived from the role are also varied, which makes the job enjoyable for us. No two days are ever alike; joy comes from interacting with a variety of people both within our firm as well as on the client side. Our nursing and healthcare expertise is relied upon extensively, but our “people skills” are also counted on, because architects are classic introverts. We achieve great satisfaction through building coalitions, managing conflict, and facilitating teams in resolving problems. There are always numerous opportunities to teach and mentor — another favorite nursing skill that gets tapped into often.

It’s hardly an easy job. We are called upon to balance priorities, often at odds, between building requirements and patient care or staff needs. Resource allocation — staffing, dollars, space, and time — continues to be a challenge for all involved. We have to go where our clients are, and so some travel is entailed, a requirement that either fits into one’s work/life balance equation or it doesn’t. And there are always deadlines, tight schedules, and sometimes late nights.

Still, the satisfaction realized by being involved in creating a new setting for patient care is unmatched. The opportunity to translate the needs of staff, patients, and families to those who design and build those settings creates a legacy that makes an impact for years to come — a legacy of spaces that are not just newer but also better, more efficient, safer, and more healing.

Banner image courtesy of NBBJ.

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What Does the Future of Urban Healthcare Look Like?

Thoughts on a ‘Healthcare Quarter’

August 6, 2018

Principal, NBBJ

Editor’s Note: This post derives from an NBBJ-hosted breakfast talk at the British Library in London focused on the future of the NHS. NBBJ Partner David Lewis was joined by speakers Jodie Eastwood, Chief Executive of the Knowledge Quarter; Peter Ward, Director of Real Estate Development at King’s College London: Guy’s and St Thomas’ NHS Foundation; and Richard Darch, Chief Executive of the healthcare consultancy Archus.

As we celebrate the 70th year of the NHS, the future of healthcare in the UK has arguably never been a hotter topic with no shortage of debate on how the world’s largest publicly funded health service will survive.

The people who work and care within the NHS remain its most valuable asset and they will continue to shape national pride in what polls have shown symbolises ‘what is great about Britain’.

But what about its places? How is the public healthcare estate adapting to the demands of an ageing population, new technologies and severe financial pressures? And how will it look in 10, 20 and 30 years’ time?

 

Creating ‘health engines’

Healthcare estates should be spaces where everyone comes together for the benefit of healthcare. Not in some utopian dream but in the form of ‘health engines’ that combine and convert the power of healthcare, research and development and industry to deliver positive progress. Instead of selling off surplus land for residential use and reducing the NHS estate, there is potential to create health ‘eco-systems’ in our cities — healthcare quarters with hospitals acting as anchor tenants surrounded by layers of research and wellness services, step-down care, commercial tenants and public social spaces.

These aspirations chime with the concept for a ‘health return’ from public assets, land and buildings to promote healthy lifestyle and wellbeing.

 

Everyone needs good neighbours

The Cambridge Biomedical Campus and Royal Liverpool University Hospital demonstrate how healthcare, research and commercial developments can benefit from being co-located. It’s important that spaces knit healthcare sites back into cities and their urban context, promote synergies between healthcare and education and create societal hubs that encourage public access and community use.

This is the point of view championed by Jodie Eastwood of the Knowledge Quarter, a partnership of more than 90 knowledge-rich organisations based around King’s Cross, St Pancras, Bloomsbury and Euston. Jodie espouses the power of cross-disciplinary partnerships saying “the real value of collaboration comes when you cross sectors.”

 

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At the Quadram Institute in Norwich, researchers and clinicians collaborate around an open atrium overlooked by research labs and balconies. (Photo courtesy of Sean Airhart/NBBJ)

Science on show

However, co-locating sectors alone is not enough. We must create buildings that actively promote formal and informal collaboration; spaces that showcase health and science in one place.

Blurring spatial boundaries can bridge the gap between fundamental research and application in practice, allowing those differing aspects of innovation to drive each other.

At the same time putting science on show, making it accessible to the public, helps to demystify scientific endeavour, while sowing seeds for education and future talent.

The Quadram Institute in Norwich is a case in point, incorporating an environment in which clinicians work alongside scientists at the forefront of food science, gut biology and healthcare research under one roof with one shared identity and entrance.

Bringing together the Institute of Food Research, the University of East Anglia and the gastrointestinal endoscopy facility of Norfolk and Norwich University Hospital, the Quadram Institute conducts bench-to-bedside research and clinical care related to health and diet.

Within a hierarchy of spaces, the clinical research facility and patient treatment areas are more private to protect patients’ and participants’ confidentiality, whilst the research space is open to showcase the science within.

 

Future proofing and flexible facilities

There are also many lessons the NHS needs to learn from when designing the next generation of healthcare facilities and buildings.

Purely clinically-led design isn’t working and must be supplemented by research-led thinking that inspires sustainable, adaptable buildings offering operational flexibility.

We must also champion strong and proven healthcare, research and technology hubs, such as the MaRS Discovery District in Toronto and UCSF Medical Center at Mission Bay, as the best breeding ground for future start-ups and world-leading innovation.

Yes, many garage start-ups have turned into multinational powerhouses but most new ventures will have a higher chance of success from being based in well-connected places that benefit from local cultural and heritage amenities.

 

Technology drives talent

Finally is the undeniable importance of digitalisation and AI to the future of healthcare and driving the talent that will drive healthcare forward. It will be fascinating to see how emerging technologies will advance the practice of medicine, improve health and empower patients to be active participants in their own care. Trends in digital diagnostics, robotics and data are allowing hospitals to put the human experience first.

For example, many hospitals in the United States are already being designed with extra-wide corridors, allowing robots to deliver medicine and other critical supplies directly to patient rooms. Meantime, IBM’s Watson is being utilized to diagnosis illnesses — especially those that are hard to detect — which then impacts the experience of patients and the quality of care they receive.

The NHS needs to sell a vision of the future now, instil public confidence and demonstrate it has a plan to create a future for itself. What’s needed is true collaboration, openness and innovation, inclusivity, community and a need to think flexibly. Don’t let’s design for just one need but let’s create a sustainable health and wellbeing community for the next 70 years.

Banner image courtesy of Timothy Soar/NBBJ.

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The Civic in the Suburbs

How to Put the “Park” Back into the Business Park

July 17, 2018

Urban Design Director, NBBJ

Editor’s Note: This post was originally published by Planetizen.

Over the past decade, the public realm — comprising streets and public spaces like parks and squares — in downtowns and urban neighborhoods has been recognized as critical to the functioning and livability of a city. The public sector is increasingly allocating funds — or trying to allocate funds — for the provision of usable open space. In city centers, developers are wise to this renewed interest in public space. A “public realm provision is integral to the branding of new developments: these spaces are heavily programmed,” hosting everything from yoga classes to farmers’ markets.

Meanwhile, ULI’s Emerging Trends in Real Estate report for 2018 [pdf] notes that as Millennials are beginning to reach their home-buying and child-bearing years, there is an expectation that demand for suburban office space will rise, bringing with it an expectation for “urban” amenities in suburban locations.

However, in the suburbs there is little or no space provided for true civic interaction.

The Challenge of the Civic in the Suburbs

Why should we care about the civic? The civic is the acknowledgement of our responsibilities to our fellow citizens; it promotes social cohesion, and, one could argue, is more important than ever in this era of political discord. Perhaps fostering a civic realm will help us know our neighbors, and we will look out for, and respect, each other; perhaps it will help mitigate the marginalization of the elderly, the infirm, and those simply viewed as “the others.”

The civic also allows us to navigate what sociologist Richard Sennett in “The Spaces of Democracy,” the 1998 Raoul Wallenberg Lecture at the University of Michigan College of Architecture + Urban Planning, described as the fundamental diversity of urban environments:

“Difference” today seems to be about identity — we think of race, gender, or class. Aristotle meant something more by difference; he included also the experience of doing different things, of acting in divergent ways which do not nearly fit together. The mixture in a city of action as well as identity is the foundation of its distinctive politics. Aristotle’s hope was that when a person becomes accustomed to a diverse, complex milieu, he or she will cease reacting violently when challenged by something strange or contrary. Instead, this environment should create an outlook favorable to discussion of differing views or conflicting interests.

Ride the Market

Private enterprise, for one, is beginning to recognize the importance of the civic realm. Life sciences campuses, technology parks, and enclaves of light industry are embracing what it means to be a contemporary and appealing workplace. They recognize that facilitating collaboration and knowledge exchange is key to attracting the best and the brightest. They understand that their employees have rising expectations about access to amenities, the outdoors, and activities that contribute to well-being.

Certainly the likes of Google, Amazon, and Facebook have suggested new paradigms for how to fulfill these objectives. Encouragingly, even housing, supporting services such as grocery stores, and community infrastructure are being introduced to business parks. Business Insider reports that “Facebook, for example, plans to put 1,500 new housing units, a grocery store, pharmacy, and shopping center in the 56-acre Menlo Science & Technology Park it bought in 2015. The company calls the development a ‘mixed-use village.’” Facebook has agreed to pay $15 million in support subsidies and projects for Menlo Park, in addition to bringing $636,000 in revenue annually.

While Facebook seems to be taking a very progressive and inclusive approach, the creation of competitive corporate campuses inevitably focuses on the employee. However, we are citizens first, and then employees.

As business parks are redeveloping to include a greater mix of uses, as defunct malls are being repurposed or literally turned inside out, and as retail spaces become harder and harder to maintain in an era of online retail, this is an opportune moment to reconfigure the suburbs, make sustainability more than a buzzword, and create inclusive places and spaces that are truly imbued with a sense of the civic.

The Civic as Connective Tissue

To provide truly public and civic space, workplaces and retail parks must not only provide for their workers and shoppers, but must also contribute to their wider environment. Similarly, adjacent neighborhoods must be able to “infiltrate” the territory of the technology, life science, or healthcare campus, as well as the shopping mall. It is the generally underdeveloped zones between the campuses and the host suburb or town that provide the greatest opportunity.

civic connectorsPerhaps the suburban civic realm should reflect why people moved to the suburbs in the first place — they wanted access to open space and proximity to nature and natural systems. Or they wanted a more intimate lifestyle, in contrast to the anonymity of the city. As we consider the suburban context, we need to find opportunities to connect with natural systems, even if only remnants exist, and exploit their potential as a civic realm. After all, hikers greet each other on a forest path despite not knowing anything about each other. People do not do this in a public square or a shopping mall.

We must find ways to extend forest into the civic realm — literally and figuratively. The often daunting physical and perceptual distances between dispersed neighborhoods and diverse people can be bridged using natural systems, much like the BeltLine currently being completed in Atlanta, or the Old Croton Aqueduct trail that connects the small towns and suburbs north of New York City. (Indeed, a retail main street could never span the full length of some of these connective routes.)

Common Ground

The civic in the suburbs has the potential to manifest in destinations that, in the best cases, provide social cohesion — the recreation center, the legion hall, the youth club. Indeed, it provides an opportunity to explore new typologies — the primary school integrated with a seniors’ home by shared outdoor ground and roof space, or the library providing apprenticeships and workshops.

No uses are better positioned to provide an environment that fosters spiritual and physical well-being than those related to science, education, and healthcare. The built form should maximize accessibility and frame a public realm that allows for inter-generational interaction, recreation, physical and intellectual mentoring, debate, and collaborative production.

As “making” and a return to the trades becomes more prevalent, we can look to these sorts of activities to frame and activate the public realm. The Design Center in Boston, which houses Autodesk BUILD, is headed this way, as are many innovation districts. We need to ensure there are activities people can participate in for free, from gardening to outdoor chess to sports — activities that cut across generations and income groups. To this end it is worth learning about temporary uses from tactical urbanism and guerilla urbanism, which allow diverse communities to collaborate to test their vision of citizenship.

Next Steps

It is a timely moment to infuse the suburbs with a civic and meaningful public realm. Unfortunately, this is also an era when public resources are scarce. Therefore, to incorporate these civic spaces into re-configured portions of the suburbs, we will need to find ways to leverage space to accommodate them. To achieve those goals, we should consider mechanisms such as:

  • development impact fees that require the private sector to provide spaces dedicated to civic activity;
  • Business Improvement Districts or Public Improvement Districts where adjacent land owners support yet give over some of their control of the space;
  • locational criteria to ensure the allocated spaces can be active and safe;
  • and design guidance and form-based codes that all new development and redevelopment must conform to — which should be produced now, before the market dictates its approach.

If we are to create a civic realm in the suburbs, we need to be proactive. The market is advanced in ensuring its own needs are satisfied, but less so for ensuring a true civic realm for all. While urban design alone cannot reinstate the civic, it can provide much-needed platforms and forums for the interaction and shared experiences that suburbs — no less than their urban centers — want and deserve.

Banner image courtesy of Google Earth.

Illustration courtesy of Kathryn Firth/NBBJ.

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