Architects Wrestling with Data: Impacts on Healthcare Design

Unfolded-elevation drawing is an example of the workflow and design methodology: programming team establishes building footprint and internal organization, which the design team develops the facade language, tectonic modules and forms.

The Transformation of Design
Throughout my career I have observed an evolution in how we deliver design to our clients. The changing landscape of delivery method relates to the integration of technology and the growing importance of data collection. Recently, while meeting with users our discussions have included computer simulation models testing crowd movement and check-in throughput; large 3D printed models with moveable pieces to allow physical space manipulation and full scale mockups that allow us to test scripted events. We’ve discussed the impacts of remote health monitoring on the exam room of the future and we are experimenting with virtual reality glasses and gloves that allow people to “occupy” designed spaces. We are creating our own computer coding to analyze complex design variables. Our databases track building parameters. Access to these tools mean we can offer greater service to our clients. New tools and knowledge enhance the process of inquiry whereby we can integrate a scientific approach within our framework of architectural humanistic values.

These changes are reflected in the shift in professional expertise across many industries. DNA analysis has changed law and medicine, computer modeling has changed engineering and data collection has changed cartography. We live in a world responding to data-driven models and metrics. In the healthcare industry, beyond the scientific and technological breakthroughs in medicine, we see the institutional model of healthcare affected through the Affordable Care Act. Healthcare delivery models are now being measured by national metrics. We see patient satisfaction surveys and infection rate tracking affecting the bottom line of our hospitals. The availability of “Big Data” influences healthcare delivery, reimbursement rates and, interestingly, architectural design. In this scenario “Big Data” is defined as structured and unstructured information produced at high volume, processed at high velocity, analyzing high variability and complexity. The discovery of relationships and trends uncovered through processing of information characterizes the revolutionary potential in “Big Data.”

The Ways Architects Work with Data
There are three different transformations to architectural processes that result when data and design intersect.

Improving communications between client and design team
Architects continually look for ways to communicate better to ensure informed and confident client decisions. In healthcare design our audiences include hospital management, clinical leadership, clinical user groups, patients and the surrounding community. We work to build consensus around a very complex building proposal.

• How do we build confidence around operational assumptions changes?
• How do we make leadership comfortable with a new design aesthetic?
• How do we best communicate with the surrounding community who might fear a new building?
• Can we employ technology to enhance traditional communication tools? And, can we build enthusiasm and facilitate decision-making with our new tools?

Virtual tools are used by design and construction firms to tackle our process and its challenges. The 3D model allows an experiential test of space and suitability of configuration through simulation similar to a full build-out of a mockup. The bar is being continually raised on the quality of presentation materials and the spatial understanding provided to our clients.

Advent of Building Information Modeling (BIM)
Construction delivery models are changing with the use of BIM. While BIM alone is not “Big Data,” it provides a platform of data to utilize for new lines of inquiry. BIM affects team structure, information flow, and document standards. The exciting potential in the existence of a large shared model of building information is that designers can launch new types of inquiry that builds from this data. Increasingly we can push building modeling to new levels to provide optimization, predictive modeling, operational and statistical analyses. We can explore building science issues like how to control heat gain or increase thermal comfort through façade design. We can understand the relationships between building configuration and occupant behavior. We can look at financial patterns that cross building parameters. BIM is not only changing the way we work today, but is opening doors to new ways we can approach work in the future.

Research as it relates to design
Metrics and utilization data are an important part of design in the healthcare industry. Increasingly we are asked to measure how we will meet goals to improve our processes and deliver the final product to the client. We look at return on investment metrics through newer lenses like: patient satisfaction, length of stay, decreased re-admits and staff retention. Architects seek to reduce the negative effects of hospitalization including slips and falls, sleeplessness, medication errors, and the spread of infection. If architects are prepared to propose, measure, track and evaluate our work with a scientific eye, we will be able to influence design decisions in areas where we have traditionally been excluded.

There are several prominent methodologies being used to bring research to healthcare design including the following: Lean/Process Development, Evidence Based Design, Patient Safety Metrics and WELL Building Standards. All of these methodologies are grounded in setting objectives and measuring end results. When utilizing one or more of these methodologies an institution can set priorities and then drive decisions to make measurable improvements in a continuous feedback loop. For instance, an Evidence Based Design project may try to decrease the prevalence of slips and falls by introducing a new flooring surface type. Measuring the current state in an institution and then substituting the new flooring and re-measuring the rates of slips and falls may show a significant decrease. That decrease can be measured monetarily in savings to hospital through shorter lengths of stay and less medical intervention. Thus the new flooring becomes a hospital standard and the results can be shared to other institutions through publications such as HERD.

The iconic window boxes on this project skew to capture views of the landscaped campus. The team calibrated visual effect with environmental performance: environmental analysis ensured that critical shading elements are maintained.

The Future of Architecture
As an architect designing healthcare projects, I see change ahead. The trends described here will grow:  parametric modeling, team approach to collecting and sharing data and research as part of architectural inquiry will continue to develop. Moreover, I believe our work will be tied to population-based medicine through “Big Data” inquiry. Kaiser Permanente is looking at building design as part of a regional strategy of healthcare delivery.

Some of our issues are broad – where will healthcare occur, will it be at home, at work or in traditional healthcare environments? How will patients interact with healthcare providers, in person or through video and telemedicine? And, to our interests, what role will buildings play?

Our challenge as architects is to lead our teams through this new world of an information driven design process and the uncertainties of new models of care. We remain professional building designers and we must continue to balance humanistic values with research based inquiry. Much of the process of healthcare design, for the design team and the users, is to cover all the possibilities, all of the what ifs. We must understand the current state … predict human behavior … anticipate change. Data and analysis will provide a stronger foundation for addressing these variables. I believe a balance of technical sophistication and design leadership will create the great healthcare spaces of the future.