Joan Saba

Joan Saba

Healthcare Architect / Partner, NBBJ, @JSLSaba
Joan is an internationally recognized expert and educator in healthcare design, in both the United States and Asia. She has received the AIA / Academy of Architecture for Health’s Presidential Citation Award, was named to Healthcare Design magazine’s inaugural HCD 10 and was also included in the magazine’s list of “Twenty Who Are Making a Difference.” A partner in NBBJ’s New York office, she lives in Connecticut.

Six Ways Technology Is Changing Healthcare Design

Amidst Rapid Change in Healthcare, One Priority Remains Constant: the Human Touch

March 26, 2019

Healthcare Architect / Partner, NBBJ

@JSLSaba

Editor’s Note: This post is adapted from a presentation delivered at the WSJ Tech Health conference on February 7, 2019.

In healthcare design, it’s difficult to predict how quickly technology will impact facilities. It takes seven to 10 years to plan, document and construct a new complex healthcare environment — that is a long time, and these buildings have to remain highly productive for 30 to 50 years. How can we even begin to think about the technology needs 20, 30, 40 years from now?

Our healthcare clients are worried about many aspects of technology today. For instance:

  • AI and deep learning: How much space do we provide for these things? How will they affect clinical workflows and the way we plan a facility?
  • Driverless cars and ride-sharing like Uber Health: Some regulations require that we provide x number of parking spaces based upon the patient volume that goes through a hospital — in some of our urban hospitals, as many as 1,000 parking spaces underground. We’re designing those to be flexible, but what about the future? Will there be a need for them?
  • Wearable devices, and how you connect with your provider: What will be the impact on ambulatory clinics? How many, and what kind, will we need? Will our patients feel isolated? What about the human touch with the care team?
  • Hospitals right now have robots delivering many materials: Will there be more? Should they share corridors with humans?

We believe there are bigger opportunities for technology to also raise our human potential and experience within healthcare facilities. For me, there are six takeaways:

  1. The virtual connection will be the norm throughout a patient’s care. We have to get comfortable with that.
  2. The virtual room will be just as important as, and maybe even more important than, the physical room, in terms of delivering care and an elevated patient experience.
  3. We want to be mindful of the potential isolation that the individual technology can bring forth. It’s important that there is still the human touch and human interaction in healthcare.
  4. The interaction between people and machines will require a whole new design approach. Already, a gap exists between technology and design, and we need to be cognizant of that in the future.
  5. Places of healing, recovery and connection are still very, very important. We are human, and we need to have those spaces alongside technology.
  6. Finally, we need to remember the basics: light, nature, the human touch and quality environments.

What will that look like? Imagine a patient room tailored precisely to you and what you require to become well. It measures and monitors your body systems and emotions, it understands your social needs, and it physically and visually adapts the room and its technology accordingly. It can predict your emotional needs, your mood, your metabolic rate, and impact them through what you see, what you feel and what you hear. It can proactively adapt so your family members can help you get well and be an active part of your care team. A space that heals you not just clinically, but socially, mentally and spiritually.

I don’t have all the answers, but it’s an exciting time. We know that technology is going to be more important today and for the future. I always return to one question: how can technology, in the field of healthcare, which has the most joyous times and the most difficult and stressful times, allow us to be more human?

Banner image courtesy Franck V./Unsplash.

All other images courtesy NBBJ.

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What Sports Medicine And Academic Medical Centers Have In Common

Everyone Benefits from High-Performance Design That Breaks Down Silos

August 8, 2016

Healthcare Architect / Partner, NBBJ

@JSLSaba

Editor’s Note: This post was originally written for the August 2016 issue of Healthcare Design.

Thinking about the August issue of Healthcare Design, at first it seemed strange to pair sports medicine and academic medical centers. But the more I thought about it, the more it made sense. Do they have anything in common, AMC facilities and sports facilities? You bet they do.

Many sports medicine programs are taking what had been a siloed service, typically just orthopedics and maybe rehab, and embracing nutrition, research, psychology, even technology and industry, with devices such as Fitbit and other innovations. What used to be segmented is now more collaborative, which will surely lead to better outcomes and a more multidisciplinary, inclusive environment for care providers, from the top orthopedic surgeons to the physical therapists and others.

At the same time, AMCs have also been innovators at breaking down the silos between disciplines—a good example is the interventional platforms that have brought surgery and imaging together. But as the example of sports medicine suggests, do we have to go beyond that? As AMCs transition to caring for the “whole person,” departments like nutrition and psychology, even industry and technology, can’t be relegated to a back corridor in the oldest building in the hospital.

But if sports medicine is taking us to new frontiers of inclusiveness, it can still learn much from academic medical centers. AMCs are 24/7 facilities—can sports facilities be 24/7 as well? How can sports medicine be integrated with ballparks, community centers, neighborhoods, restaurants and retail? Can they adopt the research and innovation mindset of AMCs and industry? Can they encourage physical activity in the community, beyond the immediate patients they serve?

And both institutions emphasize performance. Athletes, of course, understand the importance of exercise in enabling their bodies to perform at their peak; however, research also shows us that exercise also activates thinking and enables the brain to perform at its peak. For sports medicine and AMCs alike, we need to design environments for health and exercise, in order to achieve high performance of both mind and body.

So there are links of learning between AMCs and sports medicine, and it goes both ways. Likewise, we as designers need to get out of our silos and embrace other industries, other thinking, other forms of creativity, other forms of research—more so than ever, because healthcare is changing so fast. In healthcare, we must design for performance, so while we have long talked about hospitality, now we need to look beyond that, to industrial design, biology, chemistry, analytics and more. We have to be as multidisciplinary as we’re asking our clients to be. We have to bust down those silos.

Image courtesy of MilitaryHealth/Flickr.

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Eight Priorities for Healthcare in China

Designing for Experience and Performance Can Transform the Health of Millions

May 4, 2016

Healthcare Architect / Partner, NBBJ

@JSLSaba

Editor’s Note: A version of this article first appeared in UED/Urban Environment Design.

At a recent healthcare salon in Shanghai, hosted by the design firm I work for, NBBJ, we heard from physicians, policy-makers and urban planners about the challenges and opportunities China faces in securing a healthy future for its citizens. Several trends became apparent: an aging population, an increase in chronic conditions like obesity and diabetes, patient dissatisfaction, the need for clinical efficiency, a boom in new hospital construction, and more.

A range of solutions — political, economic, social — must address these challenges, but design plays a key role in bringing them all together. Specifically, design can transform both the performance of healthcare — by improving patient outcomes, or making the delivery of care more efficient — as well as the experience of healthcare — by putting patients and family at ease, enabling clinicians to perform at their best, and connecting everyone to the natural world.

Here are just a few ways design can make a difference in healthcare in China:

1. Personalized Health Journeys
China’s citizens are growing increasingly aware of the value of good health; more and more they are playing an active role in their own wellbeing, both in and out of the hospital. Where choices are available, many patients will pay for higher-quality care that is state-of-the-art not only in terms of technology and clinical practice, but also in terms of experience. As a result, a great opportunity exists for those healthcare providers who are willing to change their approach to a patient-centered experience.

2. Hospital Scale
Traditional public hospitals in China can be huge, with potentially thousands of inpatient beds. These facilities can easily overwhelm patients, which contributes to stress and makes it more difficult for them to concentrate on healing. But we can design smaller, more decentralized hospitals. We can break down the mass to be more human-scale, providing access to daylight, gardens and courtyards, and more intimate scale waiting areas. Careful wayfinding design — integrating graphics, signage, lighting, materials and architecture to help shape the patient journey — also helps patients and families negotiate larger facilities.

3. Obstetrics and Maternity Care
With the cancellation of the one-child policy in October 2015, we’ll see a shifting focus on maternity and pediatrics. In maternity spaces, which will become utilized more frequently, care isn’t just for the parents and the child, it’s also for grandparents, extended family and additional caregivers like nannies. This will require adequately sized spaces with comfortable furniture, natural light, privacy and — through using color, texture, lighting and sound quality — a sense that the patients’ time with the physician is dedicated to their new family.

4. Patient-Physician Relationships
This raises an issue that we heard repeatedly in our salon: the strained relationship between patients and caregivers. Many patients don’t trust their physicians to provide adequate care, and many physicians face daunting caseloads. Design can help in two ways: first by facilitating better relationships between the patent and caregiver, and secondly by creating calming, stress-free environments. For instance, we designed an outpatient pediatric surgery clinic in which parents can accompany their child until the last minute before surgery. With greater interaction with caregivers, trust increases.

5. Clinical Workplace
Healthcare environments are more than places where patients go to get well — they are workplaces for the clinicians who spend their days there. From working with the world’s top technology companies — Tencent, Alipay, Samsung and others — we’ve learned the importance of collaboration, flexibility and mobile work; these priorities are also necessary in designing clinical workplaces that will keep pace with changes in healthcare delivery, which is becoming more and more multidisciplinary and team-based. Collaborative workplaces not only allow clinicians to provide more integrated care for their patients, but also provide a sense of mutual support in a potentially stressful environment.

6. Sustainability
The environment matters a great deal in terms of how well and how quickly a patient can heal. We have found that, when patients have access to nature and natural light, they use less pain medication and their length-of-stay decreases. It is easy to create courtyards and roof gardens — and even adapt them to the traditions of Chinese horticulture and landscape design — in order to create pleasant environments that help patients heal faster and make staff happier and more productive at work.

There is also a tremendous opportunity to create less energy-intensive healthcare buildings. In China the public sector can mobilize resources and solve problems with great speed and efficiency. Pollution and energy consumption are widely recognized as challenges, but adhering to international green building standards — or creating China-specific standards — for new healthcare construction would send an important message to the rest of the world about the importance of sustainable design.

7. Integration into the City
True wellness is only possible when people are equipped to live healthy lives outside of the hospital: in their homes, workplaces, schools and in the streets of the city. Many hospitals are located in urban environments, where they can function both as places of clinical care as well as symbols of wellness that are incorporated into the daily life of the communities they serve. Healthcare facilities can be designed with space to host farmers’ markets, exercise programs, classes and seminars or other public events.

8. Integration of Health into Everyday Life
At their best, the experience of healthcare and the performance of healthcare reinforce each other. Better experiences — for the patient, for the patient’s family and for the physicians — lead to better outcomes, and vice versa. Great healthcare experiences can’t be implemented with a factory approach, however. It requires designers and clinicians who can understand and meet the needs of the people they are caring for.

Finally, when we think of health, all too often we think of disease treatment; in actuality, health is a network of factors — among them social connections, nutrition, economic security and the built environment — which have historically been strong in Chinese culture. If China can take advantage of these cultural traditions, blending them with state-of-the-art technology and clinical practices, it has the potential even to leapfrog Western medicine.

Image courtesy of Wikimedia.

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Five Priorities for a Healthy China

Design Plays a Crucial Role in the Well-being of Cities, in Asia and Beyond

November 18, 2014

Healthcare Architect / Partner, NBBJ

@JSLSaba

I recently had the opportunity to participate in a salon in Shanghai, where we discussed the healthcare challenges facing an increasingly urbanized and prosperous China. In many ways, those challenges now resemble those of other leading economies like the United States.

 

UrbanizationWeb-01

And the country is preparing for a building boom to meet the coming demand for healthcare environments. From what emerged during the event, I remain more convinced than ever that a transformation in healthcare environments in China will come about when we reconsider the total experience of health and wellbeing. And design will play a crucial role in that transformation.

 

HospitalBoomWeb-01

Based on our discussion, I see five attributes of next-generation care that design can bring about in China — and the West as well:

Patient Experience: The healthcare experience is really a design problem. But that experience is twofold: it depends on designing for one’s personal experience — for both patients and physicians — and on designing environments to support that experience. These aren’t separate concerns; they have to be considered together. And we know that positive interactions between people — between patients and their physicians, between clinical colleagues working in teams — lead to better care, to reduced recovery times and increased patient and staff satisfaction.

Efficiency: We have a real opportunity to design for efficiency, to allow physicians to have more of the one-on-one time that improves outcomes and increases the trust between patients and physicians. This can be achieved through Lean design, changes to clinical operations, even simply focusing resources on what will return the highest value. And people are willing to pay more for the things that bring value to their care.

Nature: The environment matters a great deal in terms of how well and how quickly a patient can heal. We have found that, when patients have access to nature and natural light, they use less pain medication and their length-of-stay decreases. We can actually measure that impact.

Flexbility: We can’t design hospitals or health systems that focus solely on the problems of today. New technology, changing clinical paradigms, disruptive discoveries in, say, genetic research or personalized medicine may — indeed, will — change the way that we think about delivering healthcare. Designing flexible facilities that can accommodate those changes is a top priority for us.

Culture: We’ve learned that successful healthcare innovation comes from a partnership between the owner, the clinicians and the designers. One can’t simply import the best hospital from somewhere else and expect it to work. To design innovations in how care is delivered, a partnership has to exist, to ensure the solution is culturally appropriate.

My vision of a next-generation hospital in China is centered on the human experience. It upholds all the positive aspects of healthy living, incorporating the best traditions of Chinese culture. It features many, many small moves that together have a big impact. When we bring those things together in the clinical environment? That’s when we’ll build a healthy China.

Banner image courtesy of Sean Airhart/NBBJ.

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Patient-Centered Care Is Bigger Than You Think

Healthcare Designers Need to Get out of the Hospital and Work on the World

January 24, 2014

Healthcare Architect / Partner, NBBJ

@JSLSaba

As a healthcare architect, I’m frequently asked about how design can improve care, especially patient-centered care (that is, the idea that patients are more engaged and see better results when their own values and desires are taken into account). It’s a great question, but many assume it applies only to the time one spends in the hospital. In reality, we have to shift patient-centered care and design away from this episodic thinking — away from merely the interaction between patient and caregiver — and think more broadly.

Wellness is much more than the absence of disease. At the urban scale, it affects education, energy, sustainability, housing, transportation and many other issues, in addition to healthcare access. Many cities are beginning to realize this, like Detroit, where medical centers and universities are partnering to encourage healthy living and urban revitalization. Or Pittsburgh, where restored waterways and walkways around the rivers’ edges invited economic development, recreation and a safe place to exercise. Now it’s practically a different city. When health leaves the hospital and applies to the entire city, that will be a major shift.

Even within traditional care environments — hospitals and clinics — there’s an opportunity to reimagine healthcare design and planning. Think about the patient room: right now a lot of great design is going on there, in terms of  family space, light, efficiency,  enabling clinicians to do their job. Many even look like hotel rooms. But what if we took a different point of view? What if we thought about the patient room as a classroom? That is, as a place where information is transferred, where clinicians educate their patients about their recovery, about managing chronic conditions, about living healthy lifestyles when they leave the hospital and enter the world. I imagine it would lead us to design patient rooms quite differently.

We already know that good design enables efficient, effective care: it reduces length-of-stay, it improves staffing, it enables clinicians to perform at their best, it helps people heal. Healthcare designers should absolutely continue to perfect these outcomes. However, now is the time for design to also enable people to live at their best out of the hospital, at home and in the world.

Photo courtesy of Flickr.

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