Tom Sieniewicz

Tom Sieniewicz

Partner, NBBJ
Tom is an architect, planner and licensed construction supervisor with a passion for people and community. He is actively involved in community affairs in the Boston area, where he has served on planning and zoning boards for the City of Cambridge and the Charles River Watershed Association. He reads Shakespeare for the fights, and he loves (and coaches) ice hockey for the lyricism.

How to Design a Hospital Triage Tent to Efficiently Screen for Coronavirus

Seven Factors Healthcare Facilities Can Keep in Mind When Designing Out-of-Hospital Testing Centers

March 19, 2020

Partner, NBBJ

Editor’s note: Our healthcare clients are on the front lines of the coronavirus crisis. We seek to support them as they courageously care for the sick. So we’re posting design ideas based on work with them, in the hope that we can contribute from our base of expertise to help combat the epidemic. From all of us at NBBJ to the many doctors, nurses and support staff in hospitals and clinics, thank you from the bottom of our hearts.

This post was co-authored by Tom Sieniewicz, George Takoudes and Tim Pranaitis.

 

As countries around the world respond to the coronavirus (COVID-19) pandemic, healthcare systems feel tremendous strain — from mask and ventilator shortages to a lack of patient beds. With the number of global cases on the rise, how can hospitals safely and efficiently test the “walking worried” — people who present with coronavirus symptoms or may have been exposed — before they step into the emergency department?

One strategy is to open a hospital triage tent, a temporary outdoor structure that is separate from a hospital’s emergency department. Here are a few factors to keep in mind when creating a similar space at your healthcare organization:

Employ empathy. Going to the hospital in any situation can be stressful, and especially so today. Creating a patient-provider experience that people can trust is crucial. This starts with understanding needs, from the “walking worried,” to nurses, doctors and security guards.

Select the right location. Identifying the right site is an important step. Is there an available parking lot nearby? Different than the drive-through testing model that was developed in South Korea, a hospital triage tent needs to be accessible to those on foot who may not have access to a car.

Consider the appropriate amount of space. Being able to test the highest number of people at one time while maintaining CDC protocols, such as social distancing of at least six feet, is critical. For example, a triage tent of 25 feet by 45 feet should hold no more than 15 people seated (but can accommodate up to 30 people total if accounting for the queue). Typically a space of that size can accommodate up to 50 people.

Select a tent with easy-to-clean materials. Providing a space that is as simple as possible to disinfect and sanitize is of utmost priority. On a recent triage tent in Boston, we coordinated with a tent company that has worked with the city’s fire department. The hospital is renting the triage tent on a weekly basis, which includes important essentials such as lighting, smoke detectors and HVAC. The walls are vinyl-wrapped tent fabric, which can be wiped down as needed and meet flammability requirements. The tent structure is aluminum and features concrete blocks to weigh it down and prevent uplift. All the furniture and fixtures were reused from the hospital.

Accommodate a safe and streamlined screening process. A triage tent must provide at minimum, space for four activities: a place for visitors to queue, a check-in zone, a waiting area and one or two private screening rooms.

Build in flexibility. In the rapidly evolving coronavirus situation, creating a space that can flex on a moment’s notice is key. The interior of the triage tent doesn’t contain interior walls, but instead uses screens that can easily move to different parts of the space for additional privacy.

Prioritize collaboration. Maintaining open lines of communication among all parties during a super-compressed timeframe can expedite the delivery process, and also make sure issues are resolved as quickly as possible. With the right approval frameworks in place, it’s possible to develop and assemble a triage tent in just a few days, which means employing rapid-fire decision-making and a design-permit-build process (that typically takes two years for a regular hospital project) that leaves no room for error. Having frequent conversations between ER staff, permitting authorities, project managers, lighting specialists as well as security and tent representatives lays the groundwork for a successful, speedy and safe project that supports providers, patients and visitors alike.

In these unprecedented times, we’re all learning new ways to be resilient, to adapt and to be resourceful. We hope the above framework helps provide insight into a new method to tackle this crisis.

 

How are you and your healthcare organization dealing with the Coronavirus? We’d like to hear from you. Drop us a line at socialmedia@nbbj.com.

Banner image courtesy Lucas Schimmak/Pexels.

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To Get to Net Zero, Cities Need to Think Wider Than Buildings

Cities Have to Embrace District-Wide Net Zero Solutions to Create Change at a Scale That Will Make a Difference

January 15, 2020

Partner, NBBJ

Editor’s Note: This post was originally published on Smart Cities Dive.

The city of Boston has recently made headlines for an ambitious new plan that mandates all new city-owned buildings to be carbon neutral, part of a wider plan for the city to achieve net zero status by 2050. The attention on this announcement and the framing of net zero makes sense — finally, there is a sustainability goal for the city that people could fully grasp and get behind, a readily understandable and appealing arithmetic proposition that the city’s buildings will eventually produce as much energy as they use.

The challenge, of course, isn’t in getting people excited about the prospect of going net zero — fervor around the term has grown with the number of buildings that meet the standard. The challenge is preparing cities for what it’s going to take to actually make net zero a realistic possibility.

An ambitious goal like Boston’s requires a total overhaul in how we think about sustainability, at every level of impact. The changes must go beyond recycling, using LED light bulbs, and even constructing net zero buildings, since individual buildings or projects can only go so far. Cities will have to embrace bigger, district-wide or neighborhood-scaled solutions that create change at a scale that will make a difference.

The city already has a good model for district energy looks like in practice with the Kendall Station power plant in Cambridge [PDF]. For years waste heat was dumped from the cooling processes of the plant’s generating turbines into the Charles River basin. The resultant overheated river water produced large algae blooms, making the river waters toxic to not only wildlife but also humans who came in contact with the algae. By virtue of a mutual agreement, today waste steam heat from the power plant is piped across the Charles River to Massachusetts General Hospital in Boston, where it is used for heating the campus in the winter and to sterilize equipment year-round. The proximity of a large hospital physical plant, which had the unusual need for steam 12 months of the year, to the power plant was a fortuitous urban condition and demonstrated the beauty of thinking about district-wide solutions for achieving net zero.

Examples like this demonstrate how we need to change the way we think and talk about sustainability. As an architect and city planner, I’ve seen time and time again how the way we communicate an idea is a powerful tool for helping people feel like they can tackle daunting problems. It’s also true that rhetoric can have the opposite effect. Solutions at the scale of the city tend to be complex. They don’t carry the catchy recognition of a well-marketed phrase like “net zero,” but they do make it possible for net zero to be a feasible goal.

I learned this firsthand during my time on the Getting to Net Zero Task Force in Cambridge. In 2015, the Cambridge City Council approved the Net Zero Action Plan, a 25-year proposal that will get Cambridge to net zero by 2040 — the result isn’t just talk but real policy, embodied in the city‘s net zero zoning. To make this work, we understood that the definition of net zero needed to be expanded. Solutions come in myriad form, including accessing green energy from out of state. After all, creating a market for non-CO2-producing energy sources outside the boundaries of one’s own city helps the planet at large. In Cambridge these offsets absolutely count towards netting out a building’s carbon footprint. So daisy-chaining energy production in neighborhoods, and yes, designing homes and buildings with an eye to energy savings so it is ultimately easier to net out the energy use with clean production need to be strategies too.

Approaching sustainability as a set of steps and achievable benchmarks can take away some of the daunting magnitude of the task at hand. In Cambridge, for instance, the city started by putting its money where its mouth was. The city is requiring all government buildings — firehouses, police stations and schools, for example — to be net zero by 2025. Next, we’ll tackle the biggest, most energy-sucking buildings — laboratories — with the goal of getting them to net zero by 2030.

But that doesn’t mean it’s impossible. In Seattle, for example, Amazon’s new downtown headquarters captures waste heat from a non-Amazon-owned data center on an adjacent block to reduce their own energy consumption. It’s just one company, and an area of only a few blocks, but it’s an important proof-of-concept that points the way forward. On an even larger scale, the United States Department of Energy has launched a Zero Energy Districts Accelerator program that is currently piloting projects in Denver, St. Paul, Buffalo, Huntington Beach and Fresno.

Designers and architects are well positioned to push net zero forward. The job is to imagine futures that don’t exist today, to generate creative solutions that speak to all of the above-mentioned scales. District-wide solutions to energy prove that, if we work together, even more powerful and kaleidoscopic solutions are possible for our mind-boggling and seemingly impossible environmental challenges. The solutions to climate change can be remarkably beautiful and may even lie in some pretty old-fashioned values, like building strong communities, relying on our neighbors and believing that design matters.

Banner image courtesy Nelson48/Wikipedia.

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Let’s Restore Hands-on “Making” and Social Justice to Innovation

Reflections on the Future of the Innovation Economy in Boston

November 15, 2016

Partner, NBBJ

“To invent, you need a good imagination and a pile of junk.”
—Thomas Edison

I love this quote from Thomas Edison, because it represents the cerebral side and the hands-on, “making” side of innovation. So often we talk about innovation as purely a matter of ideation, not of practical intelligence. Yet there are fantastic intelligences that can be gleaned from making. We invent at our peril without a pile of junk nearby.

Take batteries, for instance. Countries like Korea and China long ago took the lead in battery technology and production. Now the United States is trying to ramp up the development of batteries for sustainable energy, but with the exception of Tesla, the U.S. no longer has the knowledge. So making informs research.

This quote by Edison returned to me at a recent NBBJ salon event, which focused on the future of the innovation economy in Boston. With its world-class universities, technology companies, startups, biotech firms and medical institutions, Boston has long had the research down. But it doesn’t have the making.

Therein might be the solution to inequality. How do we spread the largesse and rewards of an innovation economy to people who don’t have a Ph.D.? By bringing making to innovation. The next Bill Gates will be fine: there are endless opportunities for people who code, but that is a rarified skill. Where are the fifteen-dollar-an-hour jobs? Where is the work for people who don’t have a college education?

By restoring making to innovation — locally, in Boston — we can build an innovation economy based on social justice. After all, Massachusetts was the first to offer public education, thanks to Horace Mann in the 1840s. The first lending library was the Boston Public Library. We have amazing, historic examples in Boston of spreading innovation as a matter of economic justice. What is this generation doing to spread innovation?

Two possibilities came up during the salon. (1) In the same way market-rate housing can be used to subsidize affordable housing, market-rate office space can be used to subsidize affordable incubator space, which could be limited to small firms that aren’t backed by venture capital. (2) Transportation. A proper transportation network, by providing access to more and more housing and workplaces, unlocks affordability.

One final thought… At a recent conference, “Innovation and the City,” hosted by Microsoft here in Cambridge, I heard it said that innovative spaces are places where people let down their guard and recognize each other’s interests and humanity. It’s a powerful sense, that empathy is critical to understanding how to make a group move forward. Are we providing the spaces where people can do that? Is it a town hall? Perhaps it was the space under the Liberty Tree in Boston Common, or the café culture of Berlin in the 1920s or Greenwich Village in the 1960s, or an extraordinary theater experience, or an exhibition of paintings, or a walk or hike in the landscape. Or is it a place to just sit by the fire and break bread? Innovation needs more than an incubator: it needs great public spaces, it needs community-building in its grandest sense.

Image courtesy of Pexels.

 

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Postcard from Quebec

What Can a 17th-Century French-Canadian Explorer Teach Us about Leadership? Plenty.

April 2, 2014

Partner, NBBJ

I find Quebec City completely magical. So do others: it is a UNESCO World Heritage site. The enchantment might stem from temperatures on my recent visit that hovered around minus 28 degrees Fahrenheit, combined with welcome and efficient central heating systems, triple-glazed windows and walls on houses often four feet thick. The “modern” core of Quebec City is completely ringed by British fortifications and walls built between 1820-50, inspired by failed American attempts to capture the city during the American Revolution and again during the War of 1812 (which the United States lost; Dolly Madison’s White House was sacked, and her china is still in Ottawa today). Daunted by these amazing earthen and stone walls and gates, we never again attacked. But just in case, even today the famously tough 22nd Royal Canadian Regiment is barracked within the city walls next to Porte Saint Louis. (So don’t try any sneaky stuff!)

Oh, French is also spoken everywhere here, with a tongue-twisting and wonderfully guttural accent, atop 180-foot-high cliffs overlooking the windy and frozen mile-wide Saint Lawrence River, on which I saw canoers miraculously paddling in the dead of winter! Well not paddling, exactly — more like leaping from ice floe to ice floe, while dragging a boat they launched into in the small areas of freezing water between massive chunks of ice, all while moving in the 3 mph current. Powered, I am sure, by unique and fantastically salty Quebecois swearwords when the crew was doused from time to time with burning cold ice-water.

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Canoeing the St. Lawrence River… Or rather, pushing a canoe across the frozen surface of the St. Lawrence River.

You may be asking, “so what?” Quebec is magical, but many cities are. However, on this recent trip with my family, its history seemed so old and yet so relevant to issues facing any enterprise trying to lead, organize and inspire itself daily around the planet.

Quebec City was founded 12 years before the Pilgrims set foot in New England and built almost immediately in stone, so it is still there. This was a city deliberately designed, planned and constructed by draftsman and explorer Samuel Champlain. How does one set out to build a city? From scratch, from Europe with only a wooden ship and a 12- to 24-week voyage across the North Atlantic, by an architect and city planner who couldn’t even swim. Yet he made 27 crossings, so we know he was either brave or stupid.

Did I mention he was a contemporary of Shakespeare? He lived more than 400 years ago, yet there is so much we can learn from him about leadership:

  • He drew — that is, planned — all the time. Champlain made records of his travels as a mapmaker and draftsman. Plan-making was at the center of his thinking. He mapped the coast from Boston to Labrador with every twist and turn of cove and river mouth. He drew and planned his settlement and buildings far in advance, packing tools, hardware, mortar and tiles (numbered) in the holds of his ships. But he also planned the way in which his inhabitants would live and work together — he was a programmer, and his city is programmed!
  • He put faith in young people. Pre-city settlement, he trusted some young explorers to winter with the Algonquians, where they learned their language and customs: in particular, the upside-down language of love, with rendezvous happening outdoors in the woods, which were private, outside the communal and public long houses. Indoors, the logical but inverted dating rules dictated that the Algonquian bachelorettes, 1970’s TV game-show-like, tapped the young men of their choosing.
  • He broke bread — okay, pemmican — with the Algonquians. He understood that he was stronger with the Amerindian than by himself. By forging ties with the surrounding peoples, the young Frenchmen’s cultural exchange meant that the new American city would be supported by those who lived around it, those who understood exactly how to extract the riches — furs, timber and fish — of the forests and rivers that surrounded Champlain’s new city.
  • He made time for fun. Champlain instituted a process by which an individual took it upon himself to raise morale for the whole settlement. This was a rotating process, and inevitably the good cheer became competitive, with each successive individual trying to outdo the last in terms of feasting and entertainment. This endeavor is critical when it is minus 28 outdoors, but does not every enterprise face periods of metaphorical “winter,” when a Happy Hour at the right moment can lift the spirit and renew a sense of possibility? Even in the dusty halls of business schools, it’s been shown that high morale and a positive attitude can raise productivity between 30 and 40 percent.
  • He understood that survival and civic life depended on the richness of collaborations. But each member of the party was also given time and supplies to advance himself within the new city. Some limited numbers of hours a week were set aside explicitly for each individual to advance his trade or garden for his own profit and wellbeing. Champlain understood that only with a perfect combination of rich connections to each other for mutual support and some deliberate time for self-interest would his city thrive and grow. These hours were spent expanding gardens, so that there could be surplus crops to sell or trade, or blacksmithing, carpentry, hunting or fishing for one’s own profit.

Champlain was courageous. He imagined a future where none was, then figured out how to realize it. There are great lessons here, in what it takes for an enterprise to survive and sustain itself, and in the qualities of leadership that make this possible.

Image courtesy of Wikipedia.

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Democracy Is a Design Process

From Reefer Madness to the Wisdom of the Collective

November 26, 2013

Partner, NBBJ

In the fall of 2012, Massachusetts voters legalized medical marijuana. As the parent of three children, I was very disappointed in the vote; I felt the liberalization of drug laws would put them at peril and might begin to send the message that it was OK to get high. I opposed this new form of access, for a society that hardly needs access to one more substance that makes us fat and lazy and drug-dependent. I already lost a brilliant family member to addiction. In my worldview, more drugs are bad.

Sure, there are medical conditions that seem to be relieved by this drug. But I was convinced that there were already legal, regulated narcotics that could ease the pain and suffering of my neighbors while not seemingly legitimizing this street drug. Disappointed on Election Day, I forgot about the issue and then watched as Washington State and Colorado struggled with even more liberal mandates from voters, illustrated on the news with video images of recreational drug users and worried public safety officials explaining — badly — the rules for the legal use of grass. I called the most sober colleague in our Seattle office one morning and asked if he had gotten high on the way to work; he did not think the question was funny, explaining that he adhered to the office’s “no smoking policy.”

Now, one year later, the Commonwealth’s new law needs to be put into effect in my city. Medical marijuana dispensaries need to be actually sited. I sit on Cambridge’s Planning Board. We shape zoning laws governing allowed uses and development details. Despite my personal inclination towards prohibition, the law is clear: No local regulation can be created that would make the siting of these drug stores impossible. (Other communities have overtly delayed the buildings with the call for “more study.”)

Then comes the night of the hearing. Proponents are present to testify. My neighbors are there. City health officials are there. Elected officials are there watching how we handle this as we sit in the 1890s Council Chambers — lofty ceilings with oil portraits, mounted on acres of proto-psychedelic patterns of 19th century wallpaper, generations of humorless, scolding mayors staring down with disapproval on our deliberations. And my convictions are contrary to everyone’s. The Cambridge Community Development staff are recommending sites at the entrances to our city — so now we will be known as the city of drugs to the hundreds of thousands who commute through here on the way to work in downtown Boston — Potland or Grasstown, with an address on the “High”way to Boston!

I know a lot about zoning regulations. I have decades of experience in public hearings; my head is full of future filibusters — words as hard as cannonballs. But the details of the rules coming from the State are … thoughtful and rigorous! The police, health officials and teachers have all been heard, and their concerns obviously shape the regulation. And all with a compassionate and caring focus on our neighbors who may be relieved of suffering and pain. I am humbled.

As a designer, I imagine the future where there is none. When I was asked to imagine the siting of medical marijuana dispensaries in my city, I pictured a future of the McDonald’s of head shops across from my 15-year old daughter’s high school. Or worse, a culture of permissive public and pervasive drug use. Instead, I am reassured by the careful recommendations of the health and planning boards, by thoughtful people who are committed to the betterment of our town through careful design. For instance, dispensaries must be designed to be somewhat withdrawn, instead of advertising their wares openly. Their names cannot contain clever puns on marijuana euphemisms (unlike, say, the title of this post). Only employees or customers with a prescription will even be allowed on-premises. This isn’t a matter of narcotics retail, I begin to realize — it’s a matter of access to healthcare.

As I listen and contribute to the deliberations, I reflect on just how closely the process of democracy resembles the process of design. Government when it works is beautiful, as beautiful as our sparkly building elevations and plans. When government works, it works as we designers work, with the approximation of a better future, which is then forged and built with multiple points of view.

Great building design and construction is too complex for one individual to conceive of and manage alone. Great city-making is no different. Cities are indeed more complex than individual buildings, and the conversations around them need to be longer, more thorough and nuanced. For this reason, I am more convinced than ever that designers are uniquely well suited to political discussion, and the outcomes of this civic design process can be some of the most satisfying and beautiful we can engage in. At its best, democracy is the public display of love.

In an age when corporate money has an inordinate influence on our politics, we need designers to get involved in government — to help us imagine just how wicked beautiful this place could be.

Image courtesy of Wikipedia.

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