“T”s not “I”s: The Next Generation of Healthcare Designers
“Never ask people. Not about your work. Don’t you know what you want? How can you stand it, not to know? How can you let others decide for you?” Howard Roark in Ayn Rand's The Fountainhead
Healthcare is experiencing its most dramatic shift in a generation with significant legislation that has the potential to impact the health of millions of Americans still in flux at the time of this writing. Complexity remains a constant, from the organizational and financial structure of healthcare systems, to our understanding of disease, prevention health, and wellness. Concurrently, the demand for healthcare architects, planners, and interior designers is growing as our population ages and life spans increase. Competency is no longer the expectation but the minimum standard; healthcare design today requires a toolbox of seemingly disparate skills and expertise. From collaboration to empathy, left to right brain, hard science, and fuzzy art, the skillsets must be as varied as the problems they are striving to solve. The design profession has come a long way since the Fountainhead, described as a reflection of ethical egoism in which individuals act primarily in their own self-interest. Instead, today the most successful practitioners embody the characteristics of the “T-shaped individual” and in no other sector of design than healthcare is this transition apparent. First described by David Guest in 1991, the vertical bar of the T represents deep expertise in a single field accompanied by the horizontal bar of knowledge across a range of topics along with the ability to collaborate across multiple disciplines. The notion embodied by Roark of already knowing what you want as a designer and not engaging with user groups or collaborating with various experts now seems almost farcical.
This understanding is not new, nor constrained only to the design profession. Thomas Edison applied this thinking and required applicants to his “Invention Factory” to take a 150 question test that included questions spanning classic Greek literature, opera and history. Today, Tim Brown the CEO of the consultancy IDEO makes the value of T-shaped individuals clear, “First, empathy. It’s important because it allows people to imagine the problem from another perspective- to stand in somebody else’s shoes. Second, they tend to get very enthusiastic about other people’s disciplines, to the point that they may actually start to practice them. ”
A salient example exists in Alvar Aalto who, in 1929, as a young architect, won a design competition for the Paimio Sanatorium in Finland. Aalto himself saw the tuberculosis sanatorium as a “cathedral of health” that’s been described as an “instrument for healing.” The facility was successful both on a macro and micro scale, with Aalto and his wife Aino designing everything from the structure itself to the interiors, as well as the furnishings and utilitarian objects including the non-splash handwashing sinks in patient rooms and sleeping bags that allowed patients to enjoy the outdoor terraces during cold weather. In some ways the relative simplicity of the program focused on a single disease enabled a single T-shaped individual to successfully complete the design. In contrast, most healthcare buildings today provide owners with a diverse and flexible platform to treat and respond to a far wider, and complex, range of diseases and health conditions. As such, the need for T-shaped designers has increased because the depth and breadth of their skillsets are required for the ever-increasing challenges of today.
In response, new interdisciplinary academic programs to inform the future of healthcare design have emerged that intentionally support the development of T-shaped individuals. One such program is the Master of Professional Studies in Healthcare Interior Design (MPS-H) launched in 2012 at the New York School of Interior Design (NYSID). The unique program brings together graduate students with either a design, or healthcare, background and undergraduate education. The program provides the opportunity to work and learn together while they acquire a broad range of knowledge of current issues, research and theory in the design and planning of healthcare interiors. Curriculum includes traditional design school classes such as studio, in addition to courses on the history of healthcare, building systems, applied research methods, the business of healthcare and more. The instructors are all adjunct faculty with one foot in academia, the other firmly planted in practice. They include professionals with wide ranging expertise and backgrounds including the sustainable healthcare leader at Perkins+Will, the director of research for Ewing Cole, the former senior director of capital planning at Weill Cornell Medical College, a current vice president at New York Presbyterian Hospital among many other experts in their respective disciplines.
Depending on the background of the student, the program prepares them for either a future career in healthcare interior design on the provider side or facility planners, healthcare design researchers and managers on the client side. Reflecting the truly global nature of design today the program is incredibly diverse, 50% of students are international with the current class including representation from Australia, South Korea, China, India, Cuba and Iran along with North America. They include individuals with existing careers in interior design along with a clinician, occupational therapist, public health expert and healthcare administrator who currently directs the daily clinical operations of 3 outpatient services at the world’s oldest private cancer center.
Today, it would be impossible for Aalto to be proficient in all skillsets needed to design a high performance facility that would meet client needs. As such, these design challenges can only be resolved through integrated design teams that present a variety of general and specialized skills and knowledge. Integrated design teams combine design specializations that are usually considered separately—in a broad sense this may include architects, interior designers, mechanical and structural engineers, research, sustainability experts, user group expertise, and so on. At a more detailed level, specialists in sterile core and operating room design, for example, may be included. The design of healthcare facilities also commands a deep awareness of complex medical equipment and how they function, further valuing the inclusion of specialists and end users.
The ultimate goal for a successful healthcare facility is to improve patient outcomes while simultaneously creating a positive experience for patients, staff, and visitors. The students in the MPS-H program with a healthcare background may be more acutely aware of potential adverse patient outcomes that can be linked to a diverse set of factors and challenges in healthcare design. This experience and contributions that result can enable them to positively impact the design of a healthcare facility in ways that someone with only a design school education cannot. Often, moving past the challenges requires a research driven approach and the implementation of evidence based design solutions that can foster insightful facility planning and design. Working with a design team member that comes from a healthcare background can provide a unique perspective and help achieve consensus with both the design team and owner’s group. As an example, one highly debated topic is the issue of planning for centralized or decentralized nursing unit stations and the relative benefits of each when considering not only how they intend to be used, but also how they may actually be used in operations. Understanding the end-user’s culture and operations is critical to recognizing which interventions will or won’t work in certain settings, one size never fits all.
An integrated design process is required in achieving high performance healthcare facilities and takes into account not just the design and construction of the building, but also the operation and end users. To exceed client’s expectations the design team needs to employ talents that stretch beyond conventional design and immerse themselves into an organization’s practices, even before design concepts and solutions are developed. A focus on not only the design but operational improvement supports outstanding patient experiences and improved health outcomes. Healthcare design has evolved as rapidly as healthcare itself with the general trend towards complexity and nuance, not simplicity. What an individual designer like Alvar Alto achieved in 1933 has evolved into a highly integrated, multi-disciplinary team of T-shaped individuals. Howard Roark likely would have trouble finding success in a discipline that celebrates collaboration, empathy, and a research driven approach led by team members with expertise and perspectives as diverse and disparate as their backgrounds.
Sustainable Healthcare Leader
NYSID MPS-H 2017
Session Assistant II Memorial Sloan Kettering
NYSID MPS-H 2017
David Guest, “The hunt is on for the Renaissance Man of computing,” The Independent (London), September 17, 1991
IDEO CEO Tim Brown: T-Shaped Stars: The Backbone of IDEO’s Collaborative Culture
Experts in healthcare design at Perkins+Will write a monthly article for Contract. Read all of the Perkins+Will healthcare articles at contractdesign.com/perkinswill.