Five Questions About How Sustainability Improves Human Well-being Here and Now, Not Just the Distant Future

An Interview with NBBJ’s Sustainability Leader Margaret Montgomery

March 4, 2019

Sustainable Design Leader, NBBJ

@MargaretMontgo1

Editor’s Note: This post is adapted from an interview originally published in the Q4 2018 issue of DesignIntelligence Quarterly.

What sustainability priorities should we focus on?

High-performance, sustainable projects are the only future that is viable for our profession and our clients. Zero carbon is viable for many projects, and we’re able to steer clients toward an achievement that’s possible for them. Material selections for reduced environmental and health impact are easier every month. Planning and site development for resilience and for a healthier urban ecosystem are equally critical.

 

You mentioned materials transparency. What are you doing about that?

We’re tweaking our specifications in areas where we can knowledgeably improve our standard options. For example, if we want to include a product, and we have enough manufacturers that are willing to disclose what’s in their product, we can require that disclosure.

We’re getting a bit more sophisticated about reducing the carbon footprint of our projects, as well. For example, what are all the concrete mixes? What’s the lowest-carbon concrete mix we can use for that particular structural purpose? How can we make sure that we are fine-tuning those mixes for the lowest carbon while maintaining performance?

The largest carbon and environmental footprint tends to be in the structure and exterior materials. The health footprint, the complicated chemistry, and the disclosures tend to congregate around the finish materials and that end of the spectrum.

 

Where do the ideas of being practical and being effective intersect best for sustainability?

If we’re doing things in the right way, we shouldn’t need to add money. We should be able to reallocate resources in a smarter way to do almost everything we want to do. So, for instance, if we create a better conceptual design — with the right window/wall ratio, better orientation and massing for passive energy flows, and we put the effort into better architecture — we should be able to spend less money on mechanical heating and cooling. To me, that’s pragmatic and effective because we’re conserving first-cost resources and getting more from our client’s money. The goal is to do that while also creating a more comfortable, more livable place for everyone who experiences it.

 

In the years that you’ve been practicing sustainable design, what changes have you observed in clients’ viewpoints?

Many of our clients recognize the value of creating space that helps them and their people be more comfortable and perform better. This was an idea that probably didn’t resonate well a few years ago because there weren’t enough studies to show the connection between what we thought intuitively were good things for people and our quantitative goals.

 

What makes you hopeful? What challenges you?

What makes me hopeful is the human spirit and the desire to make things better. You see it a lot lately in various movements outside of the building industry as well as all of the groundswell around addressing climate change. At the core, I believe we all want to make the world a better place. The challenge is how hard it is sometimes to find a common understanding or a way to communicate that gets us all headed in the same direction.

Banner image courtesy Stuart Isett/NBBJ. 

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Three Ways of Reimagining the Emergency Department

Ideas for Shaping the Emergency Department of the Future

February 12, 2019

Principal, NBBJ

Editor’s Note: This post is adapted from a white paper co-authored by Bryan Langlands and Durell Coleman, Founder/CEO of DC Design, and originally published by the Facility Guidelines Institute (FGI). The white paper is based on the “Reimaging the ED” workshop sponsored by FGI and the American College of Emergency Physicians (ACEP) and held at the 2017 Healthcare Facilities Symposium & Expo in Austin, TX, where more than 100 ED clinicians, design professionals and students gathered.

Today in the United States, nearly 50 percent of all hospital care begins in the emergency department (ED) and, over the last 20 years, ED patient volume has increased by 23 percent as many Americans use the ED to access primary care services. Many factors have contributed to these trends, including:

  • The aging of the baby boomer generation
  • Increased longevity of people with chronic diseases
  • Gaps in provision of care for behavioral health patients
  • Limited operating hours of primary care providers
  • Lack of affordable insurance and other issues affecting individual access to medical care
  • Requirement of the Emergency Medical Treatment and Labor Act (EMTALA) for EDs to treat everyone, whether they have insurance or not

While the U.S. health care system struggles to determine how to address these difficult and complex issues, there are changes that can be implemented now to improve the function and flow of emergency department services and facilitate quality patient care: by (1) improving arrival and front-end operations, (2) reducing patient length of stay, and (3) improving the experience of behavioral health patients.

 

(1) Improve arrival and front-end operations with technology.

Technology could be deployed to make patient arrival, sorting, and waiting processes more efficient. One idea: providing a registration kiosk for low-acuity patients. Another idea is a vitals-monitoring bracelet that could be used to assess and monitor patients in the waiting area. Such approaches could result in reduced stress and better flow for triage and front-end operations.

 

(2) Reduce low-acuity patients’ length of stay.

A significant problem is the treatment of low-acuity, non-emergency patients in spaces designed for patients who require a bed. Some solutions: smaller treatment spaces for these “vertical” patients, or treatment rooms that could easily and quickly be converted to hold multiple low-acuity patients during peak hours. Such spaces would speed up delivery of care for low-acuity patients and reduce the amount of time they — and consequently all patients — spend in the ED.

As one way to identify these low-acuity patients, the ED could be zoned by Emergency Severity Index (ESI) level. Creating ESI zones would support more flexible and efficient use of space and could decrease patient waiting times. Each area in the ED would be designed with patient care stations sized appropriately for the type of patient seen there.

 

(3) Create spaces for behavioral health patients.

There are many concerns surrounding behavioral health services provided in the ED setting, including the tendency to hold these patients in the ED for two to three days before placement in an inpatient unit or transfer to a psychiatric hospital. Spaces are needed that better suit this patient population. Because the ED is not specifically designed to provide care for the behavioral health population and the typical patient stays longer and requires different attention than typical ED patients, the flow and throughput of the entire emergency department is negatively affected when suitable behavioral health facilities are not provided.

 

It is important to remember the ED is not a “place” but a “process,” a point that underscores that many problems seen in EDs are the result of operational processes rather than design issues. Further, the primary factors of many problems are neither design nor operational, but issues that result from demographic changes, behavioral health and insurance deficiencies, and EMTALA requirements. For this reason, quite a few problems might not require specialty operational or design solutions if the overall health care system were doing a better job of addressing the larger issues that bring many patients to the ED.

Nonetheless, it is an important first step when health care organizations and designers work together to address operational and design problems through careful project planning.

Banner image courtesy of Frank Oudeman/NBBJ.

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Micro-Units: Good for the City, Good for Citizens?

Thinking More Holistically About Housing Typologies and Zoning Will Improve Our Public Realm

January 10, 2019

Urban Design Director, NBBJ

Editor’s Note: This post was additionally published by Building Design + Construction.

As economically booming cities such as Boston, New York, San Francisco and London struggle with housing their growing populations, there is an increasing fixation on the micro-unit in the name of increasing residential provision. Also referred to as the compact unit, architects and developers are bringing ingenuity and investment to creating spaces that have pared domestic life down to its minimalist essentials. These small units have catalyzed a new relationship with the public realm.

Looking to Europe one can see a long tradition of using the city as one’s living and dining room, where urban middle-income units are small in relation to North American dwellings. In the United States, however, it is relatively recent that Americans are choosing to live in city centers. Part of the appeal of the suburbs was the generous indoor and outdoor private space. The move downtown, where the offer is generally a smaller dwelling, has meant less private space. And so our new city dwellers are venturing out of their homes to pursue their social lives. This is good for our cities. This is good for our local economies.

But who are these micro-units for? On the face of it this “progress” is meant to help address both the accommodation of sheer numbers of people and the affordability of living in the city. However, it is impossible not to question how tiny units truly answer this need.

It has become apparent that we are creating city centers that cater to a thin slice of the population: pre-nesters and empty-nesters. The problem is threefold: the units being built are, even if not micro, rarely larger than 2-bedrooms (and a tight 2-bedroom at that); secondly, only a very small percentage are “affordable,” not to mention that the definition of “affordable” means many lower-middle-income people do not qualify for support; and, thirdly, the city’s amenities and services are often unaffordable as they cater to the affluence of those who can afford the newly built units.

For the millennials currently sharing a dwelling unit, they are forced out of the urban center to the suburbs when they want to have families. Even if housing and services affordability is not the barrier, there are few homes catering to households requiring 3-bedrooms or more. People are left little choice but to join the swathes of commuters emitting carbon, undoubtedly against their better judgement.

There is a further related concern. Thanks to policy and design guidance, many condominium buildings are designed to accommodate retail or food & beverage on the ground floor. However, despite the fact that people may be looking to the city to fulfill their entertainment needs, we find increasing numbers of empty shopfronts on our main streets and city centers. In this era of on-line shopping and food delivery, it is acutely obvious that we can no longer rely only on shops, cafes, bars and restaurants to activate our streets. Meanwhile, competing for market share, developers provide their condo buildings with gyms, meeting spaces, makers’ spaces and indoor dog runs. It is time these amenities are literally brought down to the ground. Let’s redistribute the activity.

As learning and making become more widely accessible and less institutionalized, one can imagine these sorts of uses occupying ground floors and attracting public interaction. Boston’s downtown was boosted when Suffolk and Emerson Universities came to occupy both bespoke and existing buildings. As students do not lead a nine-to-five lifestyle, ground floor activity and “eyes on the street” have improved round-the-clock.

Similarly the contemporary public library can become a space that projects and attracts vibrancy. The Idea Store in London is a good example of this. Community infrastructure — from gathering space to recreation to cultural events — provides clues as to the sorts of uses that co-exist well with the public realm. This may call for revisions to existing zoning to allow for diverse ground-floor uses — indeed, redefining “active frontage.”

The concept of the Business Improvement District (BID) has been a fantastic mechanism in many city centers, improving the safety, cleanliness and temporary events in many downtowns. However, it may also be time to redefine the scope of the BID, enforcing ground-floor activity even if that means providing space to a tenant that is not a commercial enterprise, such as a cultural institution or community use. Positive, or negative, incentives to lease empty shopfronts may be required.

It is time to promote — even demand — building types that accommodate larger households and instigate mechanisms that facilitate the distribution of amenities and services across the scale of not just a building but an urban block or blocks. This entails exploiting the trend to blur the distinction between dwelling, working, leisure and learning. In this way those people living in micro-units — as it is unrealistic, nor even desirable, that they all disappear — as well as larger multi-generation households, will have a more interesting city to venture into.

Banner image courtesy of Kamen Atanassov/Unsplash.

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