Teri Oelrich

Teri Oelrich

Partner, NBBJ
Teri Oelrich, RN, BSN, MBA, joined NBBJ as one of the first-ever clinicians to work for an architecture firm. Now with more than two decades of experience in clinical practice and healthcare design, she is a partner leading the firm's healthcare practice on the West Coast.

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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It’s Time to Design a Better Experience for Behavioral Health Patients

How to Deliver Better Care While Freeing up Hospital Space

March 28, 2017

Partner, NBBJ

Editor’s Note: A version of this post was previously published in the Puget Sound Business Journal.

The United States faces a mental health crisis, with 26% of people nationwide suffering from psychological illness or addiction. When these patients are at their most vulnerable, our communities’ emergency departments (EDs) are used as dumping grounds and holding areas due to the shortage of appropriate resources.

While any treatment is better than none, EDs are often unequipped to treat these specific patients, especially in smaller cities that are challenged by less capacity and staffing or by fewer specialized facilities. Treatment in the ED often comes with loud noises, bright lights, chaos and seclusion — which can aggravate and trigger complications for a behavioral health patient. EDs are also an expensive treatment option, increasing the cost of care for the patient and the public.

The trend of patients seeking care in EDs instead of psychiatric institutions is not new. In 1963 Congress passed the Community Mental Health Centers Act to deinstitutionalize the mentally ill. The goal was to stop “quarantining” the mentally ill and provide voluntary humane treatment. Unfortunately, this act has not been successful; the deinstitutionalization movement has been called the trans-institutional movement, with patients instead filling EDs, jails, prisons, and homeless shelters.

A Healthy Path Forward

Luckily, healthcare organizations are working with partners in their communities to overcome these challenges. For example, Kaiser Permanente and MultiCare are actively participating in programs to provide appropriate treatment for behavioral health patients — from better training of emergency responders, to preventive health measures, to better funding models.

Another solution is to redesign our treatment facilities. In Portland, Oregon, is Unity Health, envisioned by the Randall Charitable Trust. Together with a series of healthcare institutions, the trust remodeled a shuttered hospital into an inpatient behavioral health hospital with a psychiatric emergency services department. Several architectural firms came together to design appropriate spaces for care and treatment, not just stabilization until a patient is “good enough” to be released.

For example, at Unity, the typical ED exam room allows patients to dim, brighten or turn off lighting completely. While a seemingly benign solution, there is conclusive evidence on the power light has to hinder or support healing, especially with those suffering from anxiety attacks.

The project also focuses on reducing noise. When sound becomes too acute in healthcare settings, it can raise stress levels, boost blood pressure levels and require additional medication. These side effects work against providers as they seek to support their patients. The new design focuses on creating quieter spaces — using sound-absorbing materials, sliding doors and acoustical tiles to decrease noise levels.

In addition, behavioral health patients often react to each other’s outbursts, so the design relies on patient monitoring for safety. Not only does this allow for patient privacy, it also prevents patients from being put in windowless, isolated rooms.

A Call to Action

Despite the best efforts of the Affordable Care Act, the cost to treat behavioral health patients is skyrocketing. To counter the cost impact, we need to create programs for understanding, rehabilitation and prevention to ensure behavioral health patients find wellness and stay well. Studies show that for every 10% increase in mental health spending, the prison population is reduced by 1.5%. It’s clearly better to spend our resources on creating a well-balanced environment — through programs, assistance and facility design — than incarceration.

While the nation grapples with the uncertainty of healthcare under a new administration, we can take steps now to ensure patients suffering from behavioral health issues are given the tools and resources necessary to lead healthier, happier lives.

Image courtesy of Pexels.

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