What Data Can Do for Healthcare Design — And What It Can’t

How to Balance Intuition with Data: an Discussion with Metropolis Magazine

February 7, 2017

Digital Practice Leader, NBBJ



Editor’s Note: At NBBJ, we’re at the forefront of using research and technology to drive breakthroughs in healthcare, from streamlining the design process with virtual reality, to incorporating digital analytics in healthcare planning. At the same time, we know technology isn’t the only tool for solving healthcare challenges — after all, studies show the most effective care occurs when caregivers themselves are satisfied.

This week, we’re highlighting some of the human factors that must be paired with data and technology in order to bring healthcare into the future. In a recent Metropolis Think Tank event, publisher and editor in chief Susan S. Szenasy discussed the use of data in design with Eric Socolofsky, design technologist with Stamen Design; Michael Kaiser, M.D., former healthcare strategy director of NBBJ; and Marc Syp, a creative technologist and design computation leader with NBBJ. An excerpt from their discussion follows; the complete transcript can be found at Metropolis.  


Susan S. Szenasy: Let’s talk a little about energy use in hospitals. How do you use data to address its overuse? And how do your decisions affect hospital design?

Marc Syp: We’re looking at those issues in hospital renovations as well as new buildings. One of the things that a lot of our tools have in common, in terms of generating analyses and data about our designs, is that they’re trying to push all those issues much further upstream in the conceptual design process. Visualization is super important. A client always has competing interests in terms of what they’re trying to solve. If we can get all of those things on the table at the beginning, they’re much more likely to be respected or to impact the decision making.

Michael Kaiser: From a client perspective, I think some of the problem lies in the failed model of having operating costs in one bucket and renovation costs in another. The more a firm like NBBJ can tie those two buckets together in a presentation, the more understanding the client might have that it’s necessary to pay more up-front in order to get the long-term operational savings, whether that be in energy or some other factors.


Susan S. Szenasy: There’s a third bucket that we don’t often talk about, and that’s staffing. This obsession with Return-on-Investment can be damaging to great humanistic design. How do you measure ROI while making sure the nurses are happy, healthy, and taking care of their patients?

Eric Socolofsky: For what it’s worth, I think that architects and designers in general are in a unique position to be able to convince their clients that every answer isn’t in the data. There’s a reason why we have design training, and that is to apply our knowledge and past experiences to help guide decisions down paths that may be tangential or parallel to what the data is suggesting, but we know that there’s a greater responsibility to not just adhere to what the data is telling us to do.

Marc Syp: When designers don’t compliment complement data sets with their excellent intuition, they latch onto the data part and think that everything has to be a data-driven decision. The fact is that you’re never going to be able to quantify every point in your design equation. If you try to, you lose the ability to make the kinds of decisions that would probably be of great benefit to you.

Visit Metropolis for more.

Image courtesy of Pexels.

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Digital and Mobile Tech Are Part of Our Healthcare Future — But Not All of It

It Takes Both Digital and Analog Solutions to Increase Community Health and Wellbeing

February 6, 2017

Healthcare Strategist, NBBJ


Editor’s Note: At NBBJ, we’re at the forefront of using research and technology to drive breakthroughs in healthcare, from streamlining the design process with virtual reality, to incorporating digital analytics in healthcare planning. At the same time, we know technology isn’t the only tool for solving healthcare challenges — after all, studies show the most effective care occurs when caregivers themselves are satisfied.

This week, we’re highlighting some of the human factors that must be paired with data and technology in order to bring healthcare into the future. 


I had the opportunity recently to conduct a workshop in Montréal at the New Cities Summit, the annual gathering of the New Cities Foundation, an organization devoted to shaping a world where cities drive economic, social and environmental progress. The theme was The Age of Urban Tech, taking us beyond smart cities to a new wave of innovation. My workshop, the only one devoted to health, asked the question: Can digital and mobile tech increase the health and wellbeing of communities?

The answer is yes, technology can do a lot but the participants of my workshop were very clear about one thing: When technology is used it should serve the person by enhancing human interactions and help to alleviate the isolation that many folks feel when they are ill or disabled.

The participants were international and multi-generational. I broke them up into three groups to consider four distinct demographic scenarios and how mobile and digital technology, ranging from smart-phone apps to wearable health monitors to robotic companions to super smart houses and anything else they could imagine, could enable better health.


Several Common Themes Emerged

As the groups began reporting out several themes emerged that were common to all of the scenarios:

  • Human interaction, whenever and however possible, needs to be fostered. This is especially true for people who are ill and disabled. Because of the screen-to-screen nature of technology, it can sometimes lead to more isolation rather than less, by creating a false sense of connection. So while technology in all its forms is necessary to any solution, we have an obligation to ensure it serves human connections.
  • It will take everyone — governmental authorities, non-governmental organizations, local providers, advocacy groups and empowered people — to raise the level of health and well-being in communities. This includes an assurance that a solid infrastructure exists to enable technology to work flawlessly.
  • We must avoid the easy use of broad labels for groups, which only result in misaligned incentives and inadequate solutions. “Millennial,” for example, is an easy label to apply, but not all members of this generation are the same. They have different experiences, different cultures and different economic circumstances. The same can be said for every generation, so our solutions must be tailored to very particular circumstances.


How Can Technology Help?

Most participants were not concerned with all the technology that monitors human physiology and the environment. They knew from their own experiences that the technology exists, is steadily improving and will be part of our healthcare lives — whether it’s a simple application or something more robust, like telemedicine or a wearable monitor that would be prescribed in the same way a drug is prescribed.

However, participants’ interest in technology was focused around the theme of community-building. For example:

  • Increasing community participation that promotes healthy living. They envisioned an application that could gather people for informal play activities, working in green spaces and community gardens, and other outdoor activities. They were trying to create more spontaneity in both play and community gathering and take the “screen” out of their lives.
  • Deploying applications that allow people to report on environmental conditions. This was striking in the case of the dengue and Zika viruses where folks are now monitoring environmental conditions like standing water and other mosquito breeding grounds. This data is uploaded and maps are quickly generated so public health officials can act. And it empowers the individual to improve their own health by acting on their local environmental conditions.
  • Creating applications to quickly report symptoms that can distinguish between “normal” illness like a cold and more severe illnesses like flu and other high-risk communicable diseases. This will help prevent overcrowding at hospitals and track the course of the outbreak so preventive actions can be taken.


What Non-Technology Solutions Were Suggested?

But not everything will be solved with technology alone. Here are some other recommendations participants made:

  • Create food buses that go into food desert neighborhoods on a regular schedule with healthy choices at a reasonable price.
  • Reduce housing lot sizes in exchange for more community green spaces. In older neighborhoods continue the trend of creating pocket parks by recovering abandoned properties.
  • Create social mentorship networks to raise the level of personal and civic engagement. The decline of many civic and religious organizations has created more isolation, and the participants felt these networks could help in re-establishing the needed level of civic participation it will take to increase the health and wellbeing in our communities.
  • Incentivize population health by creating a public fund for initiatives that will decrease the incidence and prevalence of disease. This would be accomplished by a portion of private and public health insurance premiums going to the local community or non-governmental authority charged with implementation. In return, premiums and out-of-pocket costs would be reduced, benefiting private, government and patient payers.


Is there a gap between healthcare technology entrepreneurs and the people who use the tools they develop? Judging by the workshop, there is. Much of the technology that is being developed is purpose-driven and will succeed for its narrowly defined use case. The killer app, the one that will really drive increases in population health, is not available yet. Whatever it is, it will have to remove the artificial barrier that current technology creates and enable more human interaction.

Image courtesy of Geoff Peters/Wikipedia.

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Planning, Adapting to Rapid Change in Healthcare Design

Strategies to Future-Proof Hospitals Against Obsolescence

December 12, 2016

Healthcare Strategist, NBBJ


Ed Note: This post was co-authored by Donald Bellefeuille and Tim Fishking. It previously appeared in Medical Construction and Design.

The Hill-Burton Act was enacted in 1946 to increase the supply of hospital beds by providing construction grants to non-profit entities. It was very successful: Between 1947 and when funding ended in 1970, about a half-million additional hospital beds were added [PDF]. What the act didn’t, and couldn’t, anticipate were medical advances that slowly rendered the Hill-Burton version of the inpatient hospital virtually obsolete.


Hill-Burton era hospitals were not designed to adapt because there wasn’t much to adapt to.

Hill-Burton hospitals were a major improvement over what existed: cottage hospitals and facilities with open wards, for example. Many of the new hospitals offered double-bedded rooms and better operating and diagnostic facilities. These hospitals served their purpose well but didn’t lend themselves easily to retrofitting. Most chose to add onto existing facilities to gain more square footage and utility. Cost was no object, and adaptability was not a design feature: we just kept making more Hill-Burton-like facilities.

The 70s, however, began an era of medical technology advances that slowly made these hospitals obsolete. The first free-standing ambulatory surgery center opened in 1970, at the very end of the Hill-Burton era and, while many hospital surgical departments adapted to this change and grew their outpatient surgery business, the inpatient admissions they lost were never recovered.


We are now in an era of rapid change, and more is coming.

Today, technological and financial pressures are shuttering inpatient units, closing hospitals and, in many markets, consolidating inpatient care into academic medical centers. And these old facilities are not easily adaptable. Consider that:

  • Single-bedded rooms, deemed better at preventing the spread of infection and offering a better experience, are practically a requirement.
  • The migration of inpatient surgery to the outpatient setting has accelerated to the point that even a lot of outpatient surgery is now office-based.
  • The need for a physician to go to the community hospital to see patients, get information or even collegiality doesn’t exist. Much better and more accurate medical knowledge is available online and increasingly built into the electronic health record, hospitalists see inpatients and collegiality is built around organizations that manage at-risk contracts.
  • Machine intelligence and robotic systems will take over more and more routine logistical functions in hospitals.
  • Knowledge systems like IBM’s Watson will perform more diagnostic work.
  • Active and passive clinical robotics will quicken inpatient and outpatient operating and recovery times, rendering overnight stays, and even the less-than-24-hour stay, unnecessary.
  • Super urgent care and free-standing emergency rooms are replacing many of the functions of the traditional hospital-based emergency department.
  • Even research and training are not immune. Dry research is superseding wet research. As the new virtual world of healthcare becomes a reality, researchers will spend more time on the data generated from personalized sensors and computer modeling than on traditional animal studies. Research hospitals will struggle to adapt. We will need to produce more medical data scientists, and their residencies won’t take place in a hospital.


Inpatient hospitals aren’t going away.

Even so, we still need hospitals with beds:

  • Individual traumas will happen, requiring hospitalization.
  • Major emergencies and disasters will occur, requiring facilities to treat people.
  • There will be very sick people with multiple diseases that need intensive care.
  • Treating people with highly infectious diseases requires isolation.
  • Given the advances in healthcare nanotech, future hospitals will need to have a higher level of bio-containment than ever before to ensure this nanotech doesn’t leak into the environment.
  • Almost all births will continue to be in hospitals.


Let’s build obsolescence into our new healthcare facilities

If we must still build hospitals, they must be adaptable and able to anticipate their own obsolescence with the infrastructure to adapt and change rapidly and economically. By adaptable, this doesn’t mean designing facilities that can be added onto in a coherent way—we know how to do that. It means designing facilities where whole units, departments or functions can be easily replaced in situ without additional square footage.

We have advanced architectural, engineering and construction techniques that enable pre-fabrication and modularization. Operating and procedural rooms of all types can be assembled and reassembled easily now with no loss of infection control and utility. Wireless technology further enables this. We can take lessons from the military and how they have containerized just about everything, including patient beds and operating rooms. We need to think more about plug-and-play units, a decade at a time, housed in a shell built for the long term.


Designing Adaptability and Flexibility in Room Utilization and Facility Design

We need to move past the traditional view of a building as a static object, and instead explore opportunities for designing a building as an open-ended framework of integrated components. By developing a component logic that is highly standardized, demountable and multi-functional, key areas within the framework can be repurposed, reconfigured or replaced as requirements evolve. This reduces the likelihood of future disruption and waste and increases the potential lifespan of the entire project — a breakthrough in terms of lifecycle sustainability.

Elements of this integrated infrastructure strategy might include:

  • Permanent infrastructure elements, such as public circulation (horizontal and vertical), mechanical and electrical service areas and shafts or risers, located at the periphery of large and regular floor plates that are free of major obstructions
  • Open floorplate areas based on uniform modules of space suited for many different functions
  • Universal rooms sized and configured to accommodate a range of uses
  • Modular and/or movable casework and systems furniture

Bad adaptations serve no one well, neither patients, nor visitors nor the caregivers who work in the hospital. An adaptable and flexible hospital can future-proof itself against obsolescence, changing as healthcare changes and organic to the requirements necessary at any particular point in time.

Image courtesy of NBBJ.

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