Building Wellness: How Hospital Design Impacts Health and Community

Architecturally Speaking - Episode 11
Building Wellness: How Hospital Design Impacts Health and Community
 
Ryan Schwartz: 00:04.437 - 01:24.315
 
Hi, and welcome back to Architecturally Speaking as we kick off Season 3. I'm your host, Ryan Schwartz, and this podcast is proudly brought to you by the Ontario Association of Architects. We're thrilled to bring you yet another season of great stories, insights, and conversations about architecture. With each episode, we'll continue to pull back the curtain to give you a look behind the scenes with architects and other design professionals to explore housing, urban design, construction, sustainability, and everything else related to the world of architecture. On today's episode, we're talking about hospital design and its impact on our health and wellness. Now, as far as architecture goes, hospitals are notoriously complex buildings, so it's my pleasure to introduce an expert in the field. We have Robin Snell as a director with Parkin Architects. Robin is an experienced healthcare architect who has worked on a range of projects all across Canada for more than 30 years. Robin is an advocate for evidence-based design and leads Parkin's evidence-based design team and their post-occupancy evaluation process. I'm sure we'll get into that. He was recently named a fellow of the Royal Architectural Institute of Canada and he's vice chair of the CSA technical committee for healthcare facilities and also active on some other CSA healthcare design subcommittees. He's currently responsible for some of the largest healthcare facility redevelopments in the country and he's with us here right now. So Robin, thanks for joining.
 
Robin Snell: 01:25.775 - 01:27.116
 
Thank you very much for the introduction.
 
Ryan Schwartz: 01:27.916 - 01:33.258
 
It was a long one. So you must have quite a few healthcare projects on the go at the moment.
 
Robin Snell: 01:34.418 – 01:51.703
 
We, our office is specialized in healthcare. We have maybe 340 people across Canada, three offices, Vancouver, Ottawa, and Toronto, and we're almost about 80, maybe even 90% healthcare focused. And so, yes, we have a lot of projects on the go, coast to coast to coast.
 
Ryan Schwartz: 01:52.657 - 02:07.056
 
And, and I mentioned hospitals being sort of notoriously complicated, complex buildings, and I think that's a good place to start. So why are hospitals such technically complicated buildings and what are some of the unique challenges with, with healthcare design?
 
Robin Snell: 02:08.197 - 09:19.561
So, uh, agree. That's a great kicking off points, a great starting point. And the answer to that, uh, isn't a short one. So bear with me to you and your listeners. What will I go through? Um, it definitely a loaded topic, but essentially by the end of it, I hope you'll help understand why I'm so passionate about healthcare. Facility design. Essentially there, there are a number of interrelated topics, sort of buckets of, uh, subject matter together. But to start, essentially, it's a building type that nobody wants to go to. It can be a life and death situation. It can be a traumatic life event, typically a high stress situation. At best case, it may be a healthy birth or a diagnosis or a treatment or a rehabilitation opportunity. But for the most part, it's seldom fun and seldom a building people want to go to. We definitely have to talk about the fact that we live in Canada proudly and it's a publicly funded system so both the capital and the operating costs are entirely public. There are some private projects emanating but our focus is on the public sector ones and that's where I'll focus the conversation today. It definitely starts with the service delivery model and the functional program. So essentially in any given community, what are the key services? What are the key requirements? And we all know the pressures related to bed shortages, wait times, staff shortages, outdated infrastructure, site budgets. And so it's an omnipresent topic for us. Um, and in essence, the service delivery model and the functional program. Is predetermined largely, we get involved in some master planning with some ability to influence a little bit about what that is, but that essentially, once we get involved as the architect, that that's predetermined. Um, but at the same time, we do have some latitude to kind of challenge space requirements, adjacencies, flows, and that sort of thing. I can come back to that. Um, so really that's kind of the kicking off point for us. Um, operational efficiency is a huge part of everything that we do. There's an analogy that, uh, about 15% of the total project cost over a 50 to 60 year life cycle is for the design and construction. A relatively modest cost after that is to maintain the building and about 70, if not 75% of the total life cycle cost of a healthcare facility is the cost of the service delivery. Um, so in essence, getting to the notion of complexity, good design decisions or poor design decisions can have a huge impact on the 60 year life cycle and the operational efficiency. Um, for us, a big thing we talk about is sneaker time. You can imagine being trying to staff facilities and if we're inefficient, they need to add staff. Their staff have to travel longer. They get less time at the bedside. Um, a lot of movement of goods and materials. So how we plan it is very important for the efficiency. Um, and, and just as a matter of interest, we worked on a facility in Cornerbrook, Newfoundland, where operational efficiency was extremely important to them in a bit of a cash strapped province. And so we were able to plan the facility about 14% smaller than a typical, uh, kind of model facility elsewhere in the country through, through kind of some really tight planning efficiencies and reduce energy requirements as well as maintenance, uh, travel distances, et cetera. So that can be an important piece. Safety and security has to be discussed, of course. Typically, a post-disaster building, dire need during sort of an outbreak or pandemic scenario, of course, as we've just witnessed. But safety and security takes on a completely different meaning. you know, infection prevention and control is the cornerstone of just about everything we do. But also doing things like trying to plan and design so that we can minimize or reduce medical errors, patient falls, patient accidents, you know, improve sight lines to patients. And we also, you know, have to realize that there are also kind of violent issues, abductions, elopements, narcotic thefts, all sorts of things like that. So that's a big piece of what we do. You hit on the fact that they are the most complex buildings technically, uh, and give an example of a project we're doing in Ottawa right now, Ottawa civic hospital. It's a tertiary, paternary trauma center. It's a teaching and research facility. It has more than 46 clinical and support service departments. Um, to give an example of a planning, the density of it, the podium independent of the inpatient towers. is three football fields side by side by side with five full floors stacked in addition to an interstitial floor above it. And each one of them has radically different programs and functional requirements. So you have the emergency department, medical imaging, surgery, interventional radiology, dialysis, et cetera, et cetera. In addition to all the support services in the basement, pharmacies and sterilization, that sort of thing. Um, and so you can imagine some of the complexity of planning that. And as we're doing that technology is constantly changing equipment requirements, you know, robotic surgeries. Uh, whereas AI and healthcare infrastructural needs change. That's a lot of the complexity. And another project I can reference, uh, Trillium Mississauga project. There are almost 16,000 rooms in that facility. Now it is one of the largest in the country. So you can imagine the complexity of all the elements that go into rooms, equipment, medical gases, you know, surgical lights, all those sort of elements. Behind the scenes are tracked using our BIM modeling and data management, uh, software, et cetera. So that's complexity. Next bucket we can get into is codes. So, more so than any other building, the codes, the standards, the guidelines, project specific requirements that are usually embedded as contractual requirements are more rigorous than most other building types. Next fun bucket is procurement models when i come back to that a little bit and so given the cost involved there are a number of unique procurement models and that makes the implementation interesting. Then would you get scratching the surface of a whole range of sub specialty topics so accessibility sustainability. complexity of it systems, um, acoustics, AV, you know, even simple, something like a heliport design that has a sub section of, of specialty consultants. So larger projects will have more than 40 different consultants, all sorts of different topics. Uh, excuse me. And then at the core of it is it's still a facility for health and wellness. and needs to be a supportive care environment for the patient's visitors and staff while kind of implementing those kind of more pragmatic aspects. And really, usually it's one of the largest investments in a community. Some can have hundreds, if not thousands of staff. And it can be one of the primary civic buildings in a community. So that's the umbrella overview of a lot of what goes in to make these buildings incredibly complex.
 
Ryan Schwartz: 09:20.233 - 09:43.709
 
There's a lot to unpack there and you really touched on a lot of things and we'll try and get to most of that stuff. You mentioned, or in my introduction to you, I mentioned that some of your projects are retrofits. Is there a difference between a new hospital building versus a retrofit and the challenges? Are they kind of roughly the same? Any differences to highlight there?
 
Robin Snell: 09:44.289 - 10:16.100
 
Pretty significant difference for sure as i hinted at the codes and standards of change considerably. And are pretty well set up for new buildings and so when you start a new building the expectation to start fresh start clean and compliance with new codes is pretty clean. When you get to retrofit pieces, the complexity there, there's a lot of complexities. One of them is that they have to maintain full operations while you're doing construction and renovation. And those can be complex, multi-phase, exactly.
 
Ryan Schwartz: 10:16.501 - 10:19.004
 
Yeah, you can't just shut them down for a year. Can't shut it down.
 
Robin Snell: 10:19.504 - 10:55.693
 
At all. And so, so that can lead to, you know, occasionally it's a relatively clean scenario, but for the most part, they're, they're painful, complex, multi-phase, uh, uh, renovation projects. In addition to the notion that the. Existing infrastructure is often very old and for lack of a better word, decrepit, um, lower Florida floor heights, you know, limited, uh, mechanical electrical systems. Um, and so that it makes it a lot harder, but, but there isn't usually budget to completely retrofit and upgrade to concurrent and contemporary standards. And that puts us in a bit of a pickle sometimes.
 
Ryan Schwartz: 10:56.654 - 11:06.948
 
And you mentioned post-disaster buildings, and that's something I just wanted to highlight because some of the folks listening may not have heard that term before. And can you touch on that and where that comes from, from the building code?
Robin Snell: 11:08.038 - 12:21.339
Yeah, there's just a couple of streams. So I'll start with the building code side. So obviously we need and want these facilities to be able to exist in a disaster mode, uh, in any circumstance. So, and I think there was a small earthquake in BC on Friday afternoon, as a matter of fact. I'm so so bc for instance vancouver is the highest seismic zone risk zone in the country but but whatever is with any sort of climate disaster any sort of terrorist. Event the hospital is ground zero in essence and needs to be able to do to operate and maintain. Emergency power generation, all that sort of thing for a period of time. And so structural systems, infrastructure systems, all need to be able to kind of crank into an emergency preparedness mode to keep functioning through that time. I will add a sub stream to it, which isn't code driven, but with climate change, there's a requirement for climate resilient facilities. You know, global temperatures are increasing, the erratic effect of storms is changing. And so how can we design these facilities, not even beyond code requirements, to be resilient to climate disaster?
 
Ryan Schwartz: 12:22.519 - 12:31.442
 
And how do you do that? That was actually my next question. That was perfect. And all these complexities, and then you layer on sustainability on top of that. How do you approach that?
 
Robin Snell: 12:32.549 - 14:39.718
 
So sustainability kind of review falls under a few buckets. The first one I hinted at already. So that that's kind of the climate resilience aspect, simple aspect, you know, don't put all your. You know, major emergency switch gear in the lowest level of your hospital or where it might be susceptible to floods. Or if it is, you'd need some pretty comprehensive mitigating strategies to ensure that there isn't a risk. So that's a quick and easy, tangible example. Um, the next piece is, is trying to do low carbon healthcare. Healthcare facilities are one of the highest consumers of energy. And so how can we design facilities that have sort of a lower carbon needs? So most major projects now are going to full electrification. The burning of fossil fuels is essentially behind us, and the exception to that is emergency power generation, which is code-driven. And I'm proud to say that one of our recent projects that we opened in Cornerbrook, Newfoundland, we think is the first or one of the first zero emissions healthcare facilities in the country. It leverages Newfoundland's high use of hydroelectric power. It also has what we think is the second largest geothermal field in the country of any building type and the largest in healthcare for the heating and cooling source. So that's something we look at. The third bucket is embodied carbon. People were getting a bit better at being careful on the energy side. Um, and, and now maybe the next one for us to focus on a bit better is the notion of embodied carbon and how much of that is insisting in materials, concrete, steel, insulation, et cetera, uh, is, is part of where our focus is. Maybe the last thing I'll say quickly is. Every project across the country has a baseline requirement usually for lead certification, but I think we're learning that that's almost like a token checklist scenario and there's a lot more we can do beyond that minimum requirement.
 
Ryan Schwartz: 14:40.198 - 15:09.378
 
I agree that it helps, but it's not necessarily solving the problem. It's a step in the right direction. But I want to touch on evidence-based design. This is something we mentioned in your bio. And it's, you mentioned too that when a, when a project kind of comes along and it's, it's on your desk, a lot of the, the program requirements and things have already been decided. So these inputs in, in, in starting the design process sort of where does that come from and how does evidence-based design fit into that? And what is evidence-based design?
 
Robin Snell: 15:10.218 - 17:53.729
 
Sure, maybe I'll start with that. I think we're all pretty relieved to know that evidence-based medicine is a thing, and when they make decisions about our diagnosis and treatment, that it's evidence-based. The lightbulb went on maybe in the late 80s, early 90s by some researchers and architects that Um, maybe we can make evidence-based design decisions to drive improved outcomes. So the improved outcome might be to try and reduce a wait time or to reduce infections or to reduce falls or improve, you know, patient satisfaction, whatever it is. So, so you can, you can have a hypothesis that, that a design intervention will have a an anticipated outcome. And then you can do some fairly straightforward research, we hope, to kind of prove out, tease out whether that's actually transpired or not. Now, because that's been going on for a while, it's still a long way to go. There's a lot of literature, there's been a lot of research done to date. So our first step is that if we have a design topic that we're struggling with, Um, we can do a pretty good lit search and find out if there's any, any science essentially to, to, uh, support an idea, design idea or hypothesis that we might have. Um, it is a pretty significant undertaking to do a robust, you know, fully developed evidence-based design research study. And with millions, if not hundreds of thousands of design decisions to make, we certainly can't make them all evidence-based. So it really is a matter of curating some kind of unique and innovative aspects of a given project. to see where the evidence can be used. If you indulge me for a minute, I can talk about a pretty interesting study that we've done. It was partnered with Cornell University. It was related to wayfinding, although wayfinding was almost a subtopic Um, it was related to our Cornerbrook Newfoundland healthcare project. And essentially they developed a technique to use, uh, VR and biometric data to track the efficacy of our wayfinding solutions. And in our wayfinding solutions, the matter of using visual design cues. So things like accent paint colors, enhanced graphics on the signage, you know, lighting features, whatever the scenario might be. So, galvanic skin action, EEG, brain activity, heart rate, even electro-oculography, essentially tracking of your retina movements. So, we helped create the study and the paths and the hypothesis, and then they used their lab to test in VR whether our wayfinding cues were effective or not.
 
Ryan Schwartz: 17:55.765 - 18:29.180
 
That's pretty interesting and that actually led perfectly into my next question because I was wondering, you know, you have all this evidence but then how do you go back once the building is complete post-occupancy, people are moved in and using it and how do you evaluate how good it is as a building? And I think that's something that maybe isn't done enough, you know, not only in healthcare but in other buildings too. So, I don't know, can you speak to that a little bit? collecting that data? Is there any other methods or, you know, how do we, how do we go about evaluating our buildings when they're complete?
 
Robin Snell: 18:30.081 - 19:55.907
 
So, uh, we could talk for four hours about this easily. Um, you hit in my bio about the CSA nerd stuff that I do. So one of the standards that I was chair for is for, uh, healthcare facility design studies and post occupancy evaluation. Uh, so you've hit on a topic that's near and dear to my heart. You also hit very cleanly on the fact that it is rarely done. barely done well, we're always on to the next project, it's seldom funded, it's a really difficult thing to do. At the easiest level, we might get time and resources to do a pretty simple lessons learned scan. We might be able to do some simple interviews with staff and go in and do some evaluations to find out if some of the key design elements we had have been effective and just essentially pick up their feedback as they go. It is extremely difficult if you learn something on a given project to change after you built and occupied and funded your project there's very limited resources to making changes. So really it's about helping with the next project in the next project the next project. I will reference the quarter book study that we're doing. So the first part of the study was to do the VR analysis in a lab. The second part was to actually go do analysis before the building was occupied with volunteers. And then we will go back in a year, which is in June after it's been occupied, to actually test it real time to see how it's been affected to try and bring it through the three stages.
 
Ryan Schwartz: 19:58.009 - 20:14.226
 
And cost and funding has come up a couple times now and it's, these are public projects often. There's a lot of public funding and public committees and you know, this is taxpayer money typically, right? So how does costs, you know, how does that play a role in all this in hospital design, healthcare design?
 
Robin Snell: 20:15.439 - 21:06.452
 
Uh, omnipresent, uh, omnipresent constant element. They're, they're usually kind of financial caps to the project. There's almost inevitably a value engineering processes, several layers of value engineering processes. There's a awareness of operating costs impacts and what the impacts might be down the road. Um, numerous, uh, submissions, checkpoints, uh, estimates, uh, validation of estimates, uh, third opinion review. It's on the president what we do it we almost call it sort of budget awareness grabbing user group meeting and they're asking for additional things we have to say well that that that's a great idea we'd love to do that but. You know we have to check affordability on that or or if this is a great new initiative that you really need we might have to give up something else. on the present.
 
Ryan Schwartz: 21:06.892 - 21:37.971
 
It affects basically everything. Do you know, just kind of offhand, is there a cost per square foot for hospitals? And that's just kind of for my own curiosity. I'm just, I'm sure it's high, but do you know, is there a number for that? I'd like to challenge you. You want to guess how high? Well, I was going to compare it to residential. Yeah. Well, I'll throw a guess because I was going to guess residential is maybe just kind of as a blanket statement, maybe $400 a square foot. And so hospitals I imagine have to be upwards of a thousand, maybe more.
 
Robin Snell: 21:39.491 - 22:25.299
 
So, uh, we're getting towards, uh, 1500, even $2,000 a square foot. Now that's project costs. So it's a little bit different than a construction cost. Um, but, but the numbers are up there. They're highly, hugely complex buildings. And unfortunately the cost escalation on materials and trades, et cetera, uh, has gone up in some of our larger projects. I'll give an interesting example. The, the Mississauga, uh, Trillium hospital. The construction duration will be 10 years. So essentially it's a 10-year project to get the major project built and then come back and decommission the old hospital and do some minor renovations, etc. So you imagine if you're a drywaller and you've been asked to give a price 10 years out, that's a pretty tricky thing to analyze.
 
Ryan Schwartz: 22:27.221 - 22:53.515
 
So we've been talking kind of at a sort of a bigger scale, bigger concepts at a high level. So if we zoom in a little bit to the more granular stuff with hospital design and we're looking at things like interior design and you mentioned wayfinding, acoustics, lighting, kind of, you know, those sort of day-to-day things that people might notice when they're really in that space. What kinds of things are going into these hospital designs and how do they affect, you know, the people that have to go there?
 
Robin Snell: 22:54.975 - 27:00.678
 
Yeah, so great question. Funnel it down a little bit. I mentioned the notion of outcomes before and any aspect of design, including interior design, can have a significant role to improve outcomes. I'll get into some of the ones that you mentioned. Wayfinding is an interesting one, another one near and dear to my heart. Um, and we mentioned before that these are stressful times. These are stressful visits and they're incredibly complex facilities. Some are smaller, but, but usually they're fairly complex facilities. So finding your way around is difficult. And it's also a bit of an imposition on staff. If they're constantly being asked, how do I get to this? How do I get to that? And so. Our ability to work with signers consultants and to design an intuitive wayfinding system is really a huge priority and often times when we do visioning sessions with clients they will rank that among the top 5. What kind of priority aspects and so things like how we plan how we are we create landmarks how we draw the eye to landmarks how we create visual cue a hierarchy of spaces you don't have to find your way to the space you gotta find your way back out of it again and then maybe probably to your next diagnostic location so sometimes your visits can be fairly complex so that's a huge aspect and we pay a lot of attention to our design and queues for that. Um, clinical planning is essentially the cornerstone of what we do. Um, we can design a sort of a beautiful aesthetic facility and we can have astounding infrastructure, but for 60 years, they've got to operate that thing. And if we make some poor decisions and it's awkward, difficult, and, um, inconvenient to plan and flow and work through these spaces, um, you know, adjacencies aren't right. And that sort of thing that that's, that's really where we get ourselves into trouble. And the, So, so that's a huge, huge part of what we do. And the efficiency I already mentioned is key. I like that you mentioned acoustics. So, you know, things like sleep, uh, if you're in an inpatient unit, um, and we can control the acoustical environment and improve the acoustical environments, um, your sleep pattern is probably improved. Um, things like privacy and dignity and speech intelligibility is important so that, so that, you know, when you're registering as a patient, your, your confidential information isn't heard. Um. Which is often an open concept space so that that difficult to do so acoustics are huge. Light natural light access to views. Huge aspect a lot a lot of patients and family members like the ability to control their environment so to have different options and arrangements. for the environment. But of course, code blue, you've got to kick into gear and have the right kind of lighting for safety. If I could keep going on a few more, cleanliness is extremely important. We're really working hard to create an attractive aesthetic environment. But at the same time, we can't create things like dust lifts and shelves. We need to make things impervious materials, easy to clean. When they turn around a hospital room that the cleaning agents that they use are intense. And so it needs a lot of durability to sort of withstand and hold up to the cleaning. So for instance, we're almost never permitted to use wood or wood veneer elements in a patient room. It's usually kind of a wood look scenario by standards. So that's a huge piece. And then you get it kind of the layers of of art and decor and view and access to nature and positive distractions. All great opportunities, you know, things like abilities to connect to local community through the artwork that you're creating. We had an example in Ottawa, Oakville Hospital, Oakville Trafalgar, where they actually went and they got one of the art curators from the local gallery to essentially curate a permanent rotating art program with a really impressive level of sophistication to it. So there's lots of opportunity in interior design.
 
Ryan Schwartz: 27:01.439 - 27:31.054
 
Just makes it kind of a nicer space, yeah, for potentially an unpleasant visit. And there's the, the old architectural maximum sort of form versus function, which one comes first, which one follows the other. Pretty much everything we've talked about so far here is, is kind of function driven. So I think that for hospitals, at least it seems obvious that function is kind of. You know, at the forefront, that's the important thing that we're, we're trying to manage here. So how would you describe sort of the core purpose or the function of a hospital?
 
Robin Snell: 27:32.734 - 29:06.962
 
Um, so. I mentioned earlier that it's really about service delivery. Um, and, and so your facility might be anything small, maybe it's just a small medical imaging facility and you're trying to kind of maximize efficiency and throughput and get people to their imaging modality as quickly as possible, up to the complexity of, you know, the large 3.3 million square foot hospital with, with, uh, you know, uh, 46, 50 departments. It really comes down to adjacencies, flow, circulation, orientation on site, site lines. a myriad of different complex factors that essentially drive those elements. Essentially what we do in the earliest stages of a project is we create sort of a blocking stacking strategy, which is essentially on a floor by floor level, as well as a stacking level up through the hospital. where the most critical adjacencies and relationships need to be. So just a healthcare 101 is, you know, you have your emergency department, you have to get from emergency department really quickly to either critical care or surgery. From surgery, you have to have a connection to your medical device reprocessing area. From there, you want to be able to get to your inpatient units quickly and all that kind of stuff. So these key adjacencies essentially drive core elements of the function and the other ones kind of work and fill in. that backfill around that. Yeah. Yeah.
 
Ryan Schwartz: 29:07.043 - 29:42.322
And, and a lot of this, you know, I can see that it might be easy to sort of forget about, and all this complexity, all these, you know, adjacencies and programmatic efficiencies, it can be, I could see the potential for sort of forgetting about the individual patient, the person that's in there at the end of the day. And like the, sort of the function of the hospital is to promote their healing or something along those lines to allow them to get better. How would you describe that? How do you balance that? How do you bring that in for the person that's actually spending the night there?
 
Robin Snell: 29:42.762 - 31:28.649
 
Yeah, so one of the things that we're encouraged to do and we take great excitement to do is to consider the patient journey. and almost sort of gain or track different scenarios of a patient journey. You're coming in for dialysis or you come in as a, you know, through to the emergency department or you're expecting mother with a complex precondition or something like that. And we'll game and track the different scenarios and try and understand the flow and the path and the environment that you're going to see and perceive along the way as you do that. And as much as even, you know, tracking your ability to be an inpatient, and I'm an inpatient and I'm feeling well today and I want to be able to have space to ambulate and move around, you know, is there a spot for me to rest? Is there a nice view? Is there a good lounge? So that's the key part of it. And so, You know, in addition to tracking the departments, we're also trying to create these kind of patient and staff experiences as they go. So I'm glad you hit on that. Um, so in a fun example, I can give you again, going back to the Cornerbrook hospital is, is to try and maximize their efficiency. We compress the floor plate and stack the building and got the inpatient towers higher up, which wasn't in the program. It wasn't anticipated in the master plan. The point of that, if you've ever been to Cornerbrook, Newfoundland is, is essentially a beautiful mountainous area. And we were able to get the patients up much higher in the building with spectacular views, 360 degrees towards the harbor and towards the mountain areas, which do, including, you know, mental health lounges and things like that, terraces, you know, with great views, access to natural light. And so the point is, it's not just the efficiency, but it's the quality of the care environment at the same time.
 
Ryan Schwartz: 31:29.249 - 32:11.694
 
Yeah, it doesn't necessarily have to, I mean, on one hand, it has to be a sterile environment for cleaning and functionality, but also, you know, people have to spend time there and you're trying to make them comfortable and allow them to rest. You mentioned one thing I want to touch on is that these projects and healthcare facilities and hospitals, they're often a sort of a cornerstone in their community. And this idea of, you just sort of mentioned it too, like maybe going up to the top floor and you're getting a nice view and you have family coming over to visit. What are your thoughts on hospitals as a community hub? It's not necessarily a gathering space where you want a lot of people to come necessarily, but maybe you do. Is this a missed opportunity for hospitals?
 
Robin Snell: 32:12.815 - 34:09.052
 
Potentially. An interesting point of debate and it varies widely. Some facilities end up becoming fairly standalone. new greenfield project, lack of good property opportunities, and so they can be moved to kind of a suburban location or something like that and a little bit harder. Others are deeply embedded in urban situations. I can think of an example, the Shum Hospital in Montreal, it takes up two and a half city blocks, I think it has two metro stops. embedded sort of within the facility. You know, there are cases where we're trying to incorporate public spaces and public thoroughfare, and I think that Shum Hospital is one of the better examples in the country. Food courts, you know, exhibition spaces, et cetera, are used, and there is ability to pass through the hospital. On the flip side, if you're the Director of Infection Prevention and Control for that facility, you don't necessarily want people coming in and contracting infections. You want people bringing in more infections, so people get a little bit nervous about that sort of thing. A fun project example we did was an outpatient facility in the outskirts of Halifax, Bayer's Lake Hospital. they were expanding into a bit of a suburban area close to a really good sort of green walking path system in their park system. And so we actually were able to incorporate an extension of the walking paths for the communities to get through there. And a fun thing our landscape architect did is they incorporated berries, strawberries, blueberries in the patch. We knew it was successful when people from outside the community were coming to pick berries. I think the staff were a little miffed that they were losing their berries. It can be done. It's being done a little bit, but it is tricky at times.
 
Ryan Schwartz: 34:09.383 - 34:32.966
 
Yeah, that makes sense. And speaking of in infectious control, I kind of want to shift gears a little bit to just sort of some lessons learned and obviously we've had a COVID pandemic not that long ago. Are there any lessons learned from something like that and just, you know, designing for flexibility and the future and trying to future proof for unforeseen circumstances that we don't necessarily see coming?
 
Robin Snell: 34:33.550 - 38:45.989
 
Yeah, so two very different topics. So remind me, I'll try and come to both of them. So we'll start with the COVID thing. So yes, of course, SARS to start. So a lot of the lessons from SARS drove a lot of revised standards work. And now COVID has done and triggered a lot of revised standards work and just refund Canadian standards Association has a standard for healthcare facility design and construction, and it just rewrote and republished and changed some elements to incorporate lessons learned from COVID. And then also, there's one for the design of HVAC, heating, ventilation, air conditioning system, which you can imagine in healthcare to reduce infection is a colossal requirement. Plumbing systems, make sure regenerative disease, et cetera. don't proliferate, so lots of requirements. So those were also rewritten post-COVID. Again, we could talk all day, but I'll kind of hit on some really high-level things. First and foremost is the notion of effective streaming and screening and the notion of segregating flow and circulation between potentially infected or non-infected. Taking up more space than was anticipated and so the notion of planning lobbies and entrances and vestibules and having alternate means of access, staff access, is an important piece. Great debates over how many isolation rooms, isolation wings, isolation units, uh, might be required. And even, you know, the ocean weather or rooms, which traditionally didn't have isolation features, which is essentially anti rooms and HVAC parameters, uh, to, to, to facilitate. So there've been some changes there. Simple things like, uh, you probably saw through the pandemic, constant changing for the staff of their PPE, um, uh, for, for safety and, and, uh, reduce infection. And so, so space allocations to do that, that, that, that micro-detail of how you don and doff and dispose, etc. And one of the things we even saw is that staff during COVID couldn't leave their units, couldn't leave their departments, but had to socially separate. And so, you know, do we have adequate space for staff to go and get resp and respite? um, change and rejuvenate, uh, within units without necessarily having to leave, leave a unit or go too far. So anyway, that cuts the tip of the iceberg, but there's, there's lots more. Um, flexibility is, is also a huge thing to have a cliche saying that the only constant in healthcare design is change, um, ever changing, ever evolving. It really starts at the master planning process. Um, which in healthcare is a bit more about, uh, The service delivery and approvals process that is about more traditional university campus master planning or something like that is the differentiate. But how can we plan a campus or a site or a facility that has long term expansion built into it without spending too many dollars. on day one on infrastructure that may or may not be used for expansion. So that's always an important part of discussion. When you get into the facilities themselves, there's a lot of strategy. Again, it links to the adjacencies and flow about whether you can expand, whether you can have shell space, whether you can have soft space that can be decanted to allow potential expansion capabilities. This is something we pay careful attention to, you know, to have key major impact facilities like surgery or emergency or in fact, critical care with the ability to expand as time goes on. We all know you'll occupy a brand new hospital on day one and there still won't be enough beds in it. Then there are simple things from an infrastructural standpoint. So we'll overplan our shaft sizes to allow a little bit of space. We'll overdesign electrical rooms, TR rooms a little bit, the IT rooms. I'm just to allow additional change expansion et cetera those are the kind of a lot of the requisite things so hard to predict, so hard to guess and like i said that balance between spending on day one versus being future ready is a tricky one.
 
Ryan Schwartz: 38:47.407 - 39:09.911
 
And there is a lot of things to balance and there, you know, there's a cost associated with everything we talked about that. So, you know, in a perfect world, you know, in the future, maybe if, if money's not an issue, what, what kinds of things would you incorporate in a hospital? Like what does the hospital, the future look like in a, in a perfect world? What kinds of things would you sort of double down on or, or integrate that, that you don't necessarily see all the time?
 
Robin Snell: 39:13.913 - 41:29.336
 
Definitely a tricky question. You have the wrong guest to try and think of a world without constraints in healthcare because they're so omnipresent and the story of our lives. It's so hard to know with AI, where things are going and what sort of diagnostics or tools or treatments can be done. Virtual care is a huge unknown entity about how much can be done virtually, remotely. Um, yeah, a lot of emerging technologies that make it difficult to predict. There's also a bit of a trend right now. And I mentioned a couple of the kind of mega hospitals that are coming up, but there, there is thought that. You know maybe the mega hospital isn't isn't necessarily the best thing for the community or the most cost-effective. Wait to deliver health care huge debate debate that one for a long time. I'm into the notion to break down the projects distributed spread them around the community a little bit and it may not necessarily just because driven but it might just be a better way and more effective way to deliver care. You probably have heard a bit more about community outpatient health facilities cropping up and diagnostic facilities, and you put them in a building type that's a little bit more cost-effective and not necessarily linked into the infrastructure of a large hospital. So that's where a lot of things are moving, but, you know, maybe you also threw in there, I think I heard the words, you know, the perfect hospital. Um, and this is an OAA based podcast and maybe part of what we're skirting around is that, um, Healthcare architecture is so mired by the constraints, as we've been talking about, that it's difficult to really focus on the architecture and the design and the urban design. Um, and, you know, you know, so from, with that lens, the perfect kind of sweet spot is where we can meet all the fun complex functional parameters and efficiency and future planning, all that kind of stuff, and still really, uh, have, have good, proud architecture, uh, embedded in it. And I will say that that that's essentially the hardest thing. Um, uh, to do, that's a great answer.
 
Ryan Schwartz 41:29.376 - 41:29.576
 
Yeah.
 
Ryan Schwartz: 41:31.518 - 41:51.695
 
Um, and I guess just maybe to reframe that question a little bit is what, what kind of lessons, you know, we, there's so much research done on hospitals and healthcare design. What kind of lessons can we take from that and apply to other buildings? Is there anything that, that jumps out that we could be adopting to, you know, buildings that are a little more common condos, uh, schools, that kind of stuff.
 
Robin Snell: 41:52.424 - 44:02.459
 
Yeah, maybe not condos per se, but maybe things like, like schools or universities or, or, um, A term we didn't get into yet a little bit is which came into effect about 10 years ago with lean, uh, sort of taking, uh, industrial, uh, manufacturing efficiency, uh, process and methodology and trying to see if that can be applied to the activities in healthcare to find a, to, to make them as operationally efficient as possible. So if you're doing something like a lab or a school or a facility like that, even something like a library, how can we plan them to be as efficient as possible? Maybe there's a lesson learned. We are starting to see evidence-based design in some other building types, so lab corrections. Education is a great example. And commercial office use, what can you do to improve productivity? What can you do to improve employee satisfaction and all that sort of stuff so i think evidence-based design is starting to make its way there. I think we saw during covid that a lot of building types had to pivot and change and so maybe there are a few lessons learned from covid as far as streaming and segregation and green ability etc when that happens. I'm maybe a q and we haven't really gotten into too much is health care is really leveraging most building types are smart hospital technology. In health care there are so many systems that need to be integrated patient records no imaging records of building automation systems smart way finding. due to the iceberg that there's, you know, security, uh, et cetera, et cetera. There's so many. Integrated systems more so in healthcare than any other ones. So the, the digital infrastructure that's being created, uh, to, to service that kind of infrastructure, uh, probably has some transferability to other project types. Typically they were softwares that never spoke to each other and in separate systems. So. And I mentioned before the BIM modeling and the, the asset tracking and the data information about equipment, et cetera.
 
Ryan Schwartz: 44:03.019 - 44:15.950
 
Yeah. Things are getting more complicated. Yeah. Tracking those and looking for efficiencies and things there. Um, we covered a lot. Is there, I want to be respectful of your time here too. Is there anything that, um, we haven't touched on that you'd like to mention?
 
Robin Snell: 44:18.472 - 47:26.996
 
There's a lot. Yeah, there is a lot in this kind of feels like maybe the, the, the tip of the iceberg and there's so many different topics to be drilled down on one that we didn't get to if there's time is, is procurement models. Um, I sort of hinted at that and that really is something essential that, that, uh, drives a lot of our work. Is it okay if I say that a little bit? Yeah, absolutely. Okay. So, um, generally we find, obviously public funded, uh, healthcare, we, we want a public procurement process, um, and, and want, need to encourage that. Um, generally what's happening is that government agencies, um, for any project, let's pick a number, a hundred billion dollars or more, um, Don't want to go to a more traditional, uh, stipulated summer design bid builds a scenario because too often there was, um, Overage in both budget and schedule. And it was a lot harder to control the risk of that. Anything under a hundred million, there's a bit less at risk. So over a hundred million, there's a new. procurement model, both new 20 years ago, um, British based model, primarily Australian, which is essentially a private public partnership. Um, and that's where, um, a consortium would be essentially hired by the government agency or the healthcare facility. to a competitive forum to design build finance and potentially even maintain the facility over twenty five or thirty year period and almost like a lease back arrangement received a monthly payments. And then turn the facility back over to the order. Like I said, this was primarily devised to reduce risk of schedule and budget overruns. So the private group holds that. The key to it is, though, that it's not private health care because the health care service delivery is 100% by the health care authority and publicly funded, and then it's turned back over. In essence, what it allows the government to do, in addition to reducing risk or eliminating risk, is Do multiple more concurrent projects rather than being kind of out of pocket for a smaller handful of large projects and essentially deferring the payments over over a longer period of time and so, we talked about it before about bed shortages that's probably the highest priority and so doing everything we can to get as many beds and ERs and ORs into the community as we can. And so it's been an advantage to do that. We could talk for hours about that system. It's a complex system. It's a little bit controversial at times. It is evolving, thankfully. It's evolving to develop tools that make it more collaborative. And, and we think sort of their, their models, we got a BC, there's an Alliance model version, which is like a IBD and, um, yeah, just trying to make it a bit more, uh, collaborative, interactive. Um, and, and essentially we hope driving to, so going back to the architectural piece that sort of improved, uh, outcomes. Um, I could talk all day about that too.
 
Ryan Schwartz: 47:28.357 - 47:51.510
 
No, that's, that's good to know that things are evolving in that right direction. And actually one thing that we maybe should quickly touch on as well that we didn't, um, is accessibility. And, and that's, that's another huge topic that we could spend hours on. And in fact, there is a whole episode on that, that we did a season or two ago, but you know, these are vulnerable populations that are inhabiting these buildings. How does, how does accessibility factor into all this as well?
 
Robin Snell: 47:52.065 - 49:54.784
 
Yeah, definitely glad you brought that back. Cause cause when you sort of rank the key and core criteria, you know, when you're visioning with, with a client early on, and maybe you might pick wayfinding and sort of fifth or sixth most important to them, accessibility is usually kind of two or three or something like that. Um, hugely important to, to, uh, corporate organizations from a cultural perspective. And it gets really complex and it's not just sort of. Code based accessibility requirements are almost the absolute bare bones baseline. There are numerous standards, guidelines, written project requirements, and the difficulty is that it starts to delve into the world of equity and inclusivity, human rights, and then it also, in healthcare especially, gets complex in that you might have various impairments. So it could be mobility, cognitive, visual, auditory, any range in bariatric requirements, so patients who have heavy body mass, any range of requirements at any given time. And what's interesting for us is that the code standards requirements are often competing. So something that is a benefit to someone for visual acuity may be detrimental to someone with mobility or cognitive challenges. Um, and so it, again, to use the word omnipresent is omnipresent in everything we do. Uh, proudly, uh, Parkin opened a division called Parkin Accessibility a couple of years ago. And so we have kind of specialists who focus on nothing but accessibility and help us, um, be aware of how to navigate essentially where you often end up with competing standards and requirements to do essentially what's best for the project and best for the kind of majority of the groups that you have. So that's again a quick summary but a huge topic and I'm glad you got back to it.
 
Ryan Schwartz: 49:55.379 - 50:07.214
 
Yeah. I mean, we could unpack this stuff for days. There's, there's, there's lots here. So, um, I, I appreciate your time today. Um, if, if people want to get in touch with you, um, they can probably reach out through Parkin Architects. Is that, uh, probably the best place?
 
Robin Snell: 50:07.434 - 50:13.361
 
Yeah, you can go through Parkin Architects. You'll, you'll see, see us online, right? My email address is straightforward. snellatparkin.ca.
 
Ryan Schwartz: 50:14.414 – 50:53.142
 
Perfect. Well, that'll wrap up this episode. The first episode of season three. So please leave us a quick review, share with your friends. This will help to provide some more episodes in the future. Architecturally Speaking is available wherever you get your podcasts and also on the OAA's YouTube channel. So check that out for the full video version of today's chat. And of course, if you're interested in learning more about anything that we talked about today, you can check out the Ontario Association of Architects website for lots of additional information. That's a fantastic resource for the public and architects alike. So you can visit oaa.on.ca. And until next time, I'm Ryan Schwartz, and this has been Architecturally Speaking. Bye for now.