Influencing Action: The Power of Perspective

Clear Eyes for Climate Change Action

March 22, 2022

Managing Partner, NBBJ

On January 13, 2022, I stood on a remote saddle high in the Ellsworth Mountains; it was about –20°F, but I was geared up for the cold. The view was infinite and amazing to behold. Spectacular mountains as high as 16,000 feet and glaciers that average 6,000 feet deep below the surface spanned the horizon. I felt I stood at the very edge of the Earth—an extreme place to be, yet a place so remote that I could not deny the perspective on life and our planet it offered.

The vast Antarctica continent extending beyond the Sentinel Range of the Ellsworth Mountains.

 

To be here, a place solely of rock, ice, wind, silence and extreme cold was to know self-reliance, awe and how fragile life can be. Still, something inexplicable was happening—it had snowed several inches the night before and I would soon discover more snow was coming in a raging storm a few days off.

Antarctica is a desert—the driest continent, with an average precipitation of 1.5 inches per year. Yet more than a foot of snow fell over the two weeks I was in the Ellsworth Mountains. “Yes, our climate is changing,” I thought, “this snowstorm should not be happening.” A few days later at high camp, as a new storm raged on, I wondered if the intense 60 mph winds I was experiencing would accelerate and endanger my life, and whether climate change was the culprit. That day, in that moment, I feared climate change.

My adventure became a personal field study, clarifying what I’ve sensed, read and heard about climate change.

Storm clouds brewing over Mount Vinson’s high camp and Mount Shinn beyond.

 

Returning to Seattle, 9,000 miles from Mount Vinson and the Ellsworth Mountains, I reflected on the essence of leadership and organizational responsibilities. Leaders ensure their organization is guided by a compelling vision, relevant goals, coherent actions and on-course trajectories. Organizations that create the built environment must be concerned with the health of society.

The long journey home descending the Branscomb Glacier.

 

Advancing the health of society safeguards our ethical purpose. Ethical purpose is an authoritative force for relevancy. Being relevant guarantees success. Finally, addressing climate change guarantees relevancy.

NBBJ is a leadership intensive practice—a grand experiment where our role-based organization vests authority and responsibility with the role each of us fulfill. We express this cultural and values touchstone by highlighting that “we lead from every chair.”  This means that it is up to every NBBJer to ask, “How will I reduce carbon today?” If ever there was a wicked problem that requires leaning in, learning, looking around the corners and being proactive, it is the challenge to become a net-zero carbon society.

Perspective is powerful.

We must act now to create sustainable, resilient, zero-carbon experiences, buildings, and communities.

 

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Four Ideas to Improve Hospital Work Environments To Help Combat America’s Nursing Crisis

Hospital design experts Teri Oelrich and Bryan Langlands explore ways to improve the efficiency and experience for nurses in hospital settings

March 14, 2022

Partner, NBBJ

A version of this piece originally appeared on Forbes. It was co-authored by Bryan Langlands and Teri Oelrich.

 

Two years into the Covid-19 pandemic, frontline nurses report feeling overworked and burned out—and the US is in the throes of a nursing crisis. While the pandemic has undoubtedly contributed to nurses’ stress and fatigue, the nursing population is unique, as are the factors contributing to the staffing shortage. A significant segment of the nursing population is nearing retirement age, while changing demographics signal a need for more nurses to care for an aging society. And while nursing school applications are up—a positive trend—enrollment is still not growing fast enough to meet the projected demand. Lastly, nursing has one of the highest turnover rates in the medical profession, with 16.5% of all nurses employed in hospitals quitting their jobs within the first year, costing hospitals $4 to $6 million annually.

“The nation’s healthcare delivery systems are overwhelmed, and nurses are tired and frustrated as this persistent pandemic rages on with no end in sight. Nurses alone cannot solve this longstanding issue. If we truly value the immeasurable contributions of the nursing workforce, then it is imperative that HHS utilize all available authorities to address this issue,” says American Nurses Association President Ernest Grant.

While we as designers are removed from administrative or policy decisions, we can create environments that improve operations, efficiency and working conditions. Here are four ideas to consider when planning and designing better work environments for nurses and other staff on inpatient bed units.

Plan for Efficiency

To achieve an efficient nursing unit, it is important to focus on the number, type and location of specific rooms; provide adequate support space; plan layouts and grouping of patient rooms that align with nurse-to-patient staffing ratios; and provide space and features that support and welcome non-dedicated staff.

Understanding how nurses work and allowing that to inform the layout of a nursing unit results in a better-functioning care environment. On average, nurses spend only 31% of their time with patients, while the remainder of their time is dedicated to activities such as waiting for lab data responses, patient transfer, searching for required equipment and documentation. For example, aside from patient rooms, the rooms most frequently accessed by nurses are medication, clean and soiled rooms—so, the number and placement of these rooms are critical to allowing nurses to spend more time with patients.

An effective nursing unit design solution is called “open core.” In an open core hospital design, patient rooms are located on both sides of a central work zone corridor, eliminating physical imped­iments within the areas of direct care. Between the banks of patient bedrooms, anything not related to direct patient care (such as elevators, mechanical shafts, stairs, electrical closets, offices, and toilets) is removed, leaving an unobstructed area to create an effective care team workplace. The standard eight-foot-wide corridor seen in many hospitals is doubled to sixteen feet. This accommodates circulation a clinical zone that houses decentralized team workstations, and supply and equipment alcoves stocked with the most frequently accessed items by staff. In addition, this layout creates neighborhoods for caregivers that locate nursing staff near patient rooms and supplies, with greater access and visibility to both.

An example of an open core hospital design at Mount Carmel Health System’s East campus in Columbus, OH. The design features double-width corridors and caregiver “neighborhoods” that place nurses in closer proximity to both patient rooms and supplies.

 

Select Finishes, Fixtures and Equipment That Improve Working Conditions

The Covid-19 pandemic highlights the limitations of many design elements that have been used for decades, and positively reinforces design advancements introduced on newer nursing units. One example is the advantages of glass over solid doors. Feedback from nursing staff on older units with traditional solid wood swing doors to patient rooms indicates that these types of doors contribute to staff isolation and compromised communication. Full-height glass doors, whether swing or sliding, allow for greater situational awareness, the ability to nurse from outside the room, maintain sight lines to patients, improve visual communication, increase natural light to the support areas, and reduce social isolation.

Motorized overhead patient ceiling lifts are another example of a solution that can be included at the beginning of a project. However, these lifts are often one of the first things to go when construction projects are over budget. While removing these pieces of equipment results in initial savings, injured staff and days away from work may end up costing hospitals far more in the long run. According to a 2018 article published by the Bureau of Labor Statistics, overexertion and bodily reaction as a result of excessive physical effort (bending, twisting, lifting and repetitive motion) accounts for 45.6% of all injuries occurring to nurses, and work-related musculoskeletal disorders resulted in 8,730 days-away-from-work among nurses in the private industry. To reduce occupational hazards and benefit nurses, patients and the healthcare system, keeping ceiling lifts in the project is optimal. Another solution is to provide the infrastructure—structural support and tracks—so ceiling lifts can be added in the future.

Embrace Technology to Save Time and Enhance Communication

Service robots, or automated guided vehicles, can make life better for nurses and staff working on units by performing simple yet time consuming tasks like delivering supplies directly to the unit, the room and even the patient. On many nursing units, technicians meet robots outside patient rooms, where they unload nurse carts and put away supplies, while new robots pick up the empty carts and quickly flip them for their next use. They can also keep workers safe by transporting supplies in areas where pathogens are a risk—an added benefit discovered during the pandemic. Other healthcare technologies like radio frequency identification and real-time location systems minimize time lost looking for equipment and can lead to an overall reduced inventory need.

In addition, nurse call systems now offer digital wall staff terminals which enable nurses and housekeeping staff to indicate whether a room needs servicing or has already been serviced—and what specifically is needed—by simply tapping a screen. Similar technology puts the control in the hands of patients and their families with digital tablets. These tablets can be used to control lights, temperature and window shades in patient rooms while also allowing patients to order meals, watch educational material customized to their ailment and recovery, and even FaceTime with friends or family members.

Finally, wearable devices allow nurses to communicate without having to leave the patient room, and more easily and accurately request help. These types of communication devices can also contribute to reduced noise and disruption to patients as they eliminate the need for overhead intercom systems.

Bring Amenities to the Unit to Reduce Stress

Like airports—which provide a variety of dining and seating options, Wi-Fi and computer access, and amenities like massages or yoga immediately adjacent to the gate—bringing amenities onto nursing units allows nurses and other staff to refresh and regroup “off-stage” without the stress of leaving their post. In a virtual roundtable with leaders from healthcare systems in the U.K. and U.S., participants noted that on-unit staff support spaces and convenient access to things like lactation rooms, showers and healthy food made a tremendous difference in quality of life for frontline caregivers. These amenities are also scalable, with some requiring little added space or cost. For example, small scale solutions like the creative use of small alcoves or leftover spaces such as the informal opportunity areas off stairwells or corridors, improvements to shared spaces like bathrooms or common areas, healthy food delivery or grab-and-go options, or the installation of rest pods are easier to implement than a large, centralized café, gym or wellness space—and are often more useful given the close proximity to nursing units.

Recently, institutions have started providing other concierge services to staff with the goal of increasing employee happiness and satisfaction and improving retention and recruitment. While amenities like staff retail pharmacies have been in existence for years, healthcare institutions are now incorporating services like day care, pet care, dry cleaning, salon services and made-to-order food to take home after a shift.

America’s nursing crisis is complex, and the staffing shortage may seem dire, especially amid the Omicron surge and the continued exhaustion felt by nurses and healthcare workers alike. Design solutions, technology and services that improve working conditions and prioritize efficiency, well-being and satisfaction can help to attract and retain nursing talent and create a better experience for nurses and staff.

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Urban Waterfronts Should Be Designed to Protect Our Communities

Four Strategies to Balance Equity, Ecology and New Development When Designing and Planning for Waterfront Revitalization

March 7, 2022

Principal, NBBJ

This post was co-authored by Alan Mountjoy and Margot Jacobs.

 

For the latter half of the past century, our urban waterfronts have undergone a major transformation, from working waterfronts to places defined by leisure, recreation and economic development. In particular, the past 20 years have seen a wave of redevelopment that transformed formerly heavy industrial waterfronts to a knowledge-based economy.

Enabled by the passage of the Clean Water Act, a wave of projects—from innovation districts and multi-purpose amenities to green habitat corridors—continue to redefine river, lake and ocean shorelines. As we look to the next chapter of our waterfronts, we now have another set of environmental, social and economic factors to consider. How do we build on the momentum of these new projects while balancing equity, ecology and new development along the way? In this post, we explore four strategies to consider when designing and planning for waterfront revitalization.

Prioritize Resiliency

Although coastal cities have a more obvious challenge with rising sea levels, every community needs to become more resilient and adaptable in the face of climate change and evolving natural stressor events such as heat waves and higher intensity storms. With climate events like “100-year floods” occurring more frequently, green infrastructure—in the form of public parks, wetlands and grasslands, urban forests, green roofs and rainwater gardens—is our most affordable, effective and beneficial strategy in protecting cities from the impacts of climate change.

Thoughtful solutions can restore the natural systems that have been lost in prior industrial development and address multiple goals like reducing flooding risk, reducing heat islands, improving water quality and restoring natural habitats. For example, Louisville’s 85-acre Waterfront Park is designed specifically to flood when the Ohio River breaches its banks. This intentional inundation reduces downstream impacts by providing additional flood storage lost to prior industrialization of the flood plain. And in Shantou, China, a new urban design vision locates the densest areas of commercial and residential development inland, away from potential coastal storm surges thus freeing up the coastal waterfront for public space and cultural uses. As in Louisville, the park is designed to recover from episodic flooding with resilient design that can easily and quickly be regenerated after an event.

The urban design vision for Shantou, China’s, waterfront places the densest zones inland and connects to existing river systems by a series of canals.

 

Shift Perceptions

In many places, redeveloping waterfronts also requires a generational shift in perception and working with communities to help them reimagine waterfronts with entrenched—and often negative—reputations.

In Pittsburgh, the Riverlife Task Force had to counter years of negative storylines and neglect of the city’s once polluted and dangerous waterfronts that housed the city’s famous steel mills. Over the course of the last two decades, the Task Force has shifted public sentiment through persuasive lobbying, continuous public forums and generous funding to ensure full pedestrian access to miles of former industrial waterfront and active recreational use of the rivers despite concerns from barge operators who still ply the rivers. Today, Pittsburgh’s Three Rivers Park has successfully transformed into the city’s preeminent open space system, hosting nearly all the city’s celebrations and public events with new shoreline parks, sports venues and commercial and residential development facing the cleaner rivers.

The legacy of industrial waterfronts is also characterized by numerous barriers between residents and the waterfront where railways and highways have been located close to shorelines. These places are frequently near to lower income neighborhoods where working people lived to serve the labor needs of maritime industry. In addition to lack of access, lower-income communities have traditionally seen much lower rates of investment—in part because they are more likely to be located near un-remediated environmental hazards. Ensuring that waterfront planning efforts are done with full participation of the adjacent communities, and that brownfield remediation and other decontamination strategies are implemented to address the residual impact from previous industrial uses is critical to environmental justice goals and improving access and health benefits to residents.

Focus on the Human Experience

Cities have been settled along bodies of water for the benefit of commerce for millennia. But proximity to water is more than simply an economic equation. In Blue Mind, marine biologist Wallace Nichols outlines the myriad benefits we experience through our connection to bodies of water—including altering our neural pathways in ways that make us calmer, happier, healthier and more connected to ourselves and others. It’s no wonder that people in cities are looking for evermore opportunities to be reconnect to their waterfronts after industry made them inaccessible for decades. This compels a shift in thinking in how we design for waterfronts—employing an approach driven by human experience, mental health and reconnection to nature.

The next generation of multiuse and multi-beneficial projects compel a shift in thinking in how we design for waterfronts, employing an approach driven by human experience, mental health and reconnection to nature. The Mahoning River Corridor Revitalization Plan, that covers a 25-mile corridor through former steel industrial corridor in Northern Ohio, does just that. The comprehensive open space network provides convenient access a once highly polluted riverway with recreational amenities—including water demonstration gardens, an environmental learning center, and floating agriculture—for residents of Mahoning and Trumbull Counties and the region. The removal of former low-head dams allows visitors the chance to see, feel and interact with a cleaner river and myriad wildlife that has returned to its banks and the chance to kayak and swim in a newly free flowing river.

When restoring waterfronts, it is also crucial to work with underlying dynamic processes and other environmental factors rather than fight against them. Development should be grounded in the ecology of the surrounding area, working with natural systems. In some landscapes, it is also necessary to amplify the natural protections systems such as sand dunes, kelp beds, mangroves or even fallen logs to protect against climate change while still harnessing the natural defenses inherent in the original landscape processes.

Redefine the “Working” Waterfront

Despite years of disinvestment in waterfronts due to offshoring of heavy industry and the consolidation of global maritime cargo into larger containerized ports, we are seeing a return to the “working waterfront” with more light-industrial uses—from prefabrication assembly sites to artisanal creative industries—coming back to our waterfronts. For example, the Brooklyn Navy Yard in New York, which served as America’s premier naval shipbuilding facility until it was decommissioned in 1966, is currently undergoing its largest expansion since WWII and is now home to organizations ranging from film and television production studios to a Green Manufacturing Center and the country’s largest rooftop farm.

However, the transformation of our waterfronts from heavy industry and maritime uses and the various forms of gentrification that creative clustering can trigger inevitably creates unease around existing livelihoods and fears of economic displacement. In Boston, where the waterfronts are under strong pressure for redevelopment, commercial developments are exploring a hybrid model: incorporating traditional water-dependent industry at the ground floor while reserving the upper floors for offices and biotechnology laboratories that cater to the market demand.

Commercial developments on Boston’s waterfront must cater to a true mix of uses including traditional maritime industry as well as science and technology companies. 

 

Finally, while the idea of a working waterfront may still call to mind billowing smokestacks or crowded, polluted conditions, today’s definition of industry is not the same as it was just 50 years ago. Waterfronts that were once dominated by oil and energy importing and refining facilities now serve as places where we export oil from shale and ports on the East Coast—in places like North Carolina, Rhode Island and the Gulf of Maine—are transitioning to places for deployment of offshore wind.  The so-called Blue Economy promises to exploit more of our oceans for sustainable industries only just emerging in research labs.

Waterfront redevelopment is a delicate balancing act, reconciling economic opportunities with an equal concern for equity and resiliency. This moment, even with all its uncertainty, provides planners an opportunity to design the future of our waterfronts in a way that can protect our communities while building toward a more environmentally sound future.

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