MARDELLE SHEPLEY: Well, what I'm going to do is we're going to have a couple of interdisciplinary activities going on, here, as part of this, because that's part of what we're about with the new institute. I'm going to start by introducing each of them for them, because mostly, when you ask people to tell them about themselves, they say, I did [MUMBLES]. So you don't actually get the whole story.
So I will give you that information. Plus they gave me a little fun factoid about each. So I would like you to listen to each of them. Because when they're done, even though you're probably not an architect or one of their affiliated-- a landscape architect-- I want you to identify the person with whom you most closely affiliate.
So, as you hear each one, think about it. And I'm going to ask, after I do the introductions, by show of hands, you know, who is with Naomi?
NAOMI SACHS: Oh my god! [LAUGHS]
MARDELLE SHEPLEY: So, no pressure.
NAOMI SACHS: This is going to start feeling like a popularity contest.
MARDELLE SHEPLEY: And you can only vote once. So what we'll do is, I'm going to do those introductions, and then I'm going to allow them to give brief presentations. My first two presenters are presenting, or have presented, in other sessions, their slides, so they'll be giving you an oral presentation, without a PowerPoint behind it. And the last two presenters, who have not had that opportunity, are going to be showing you slides. So we mix up the presentation formats a little bit.
So, they'll present, and then I'll give you the opportunity to ask questions regarding clarification, at the end of each presentation, but just a minute or two. And at the end, we'll open it up to the whole group. But meanwhile, I have asked each of the panelists, after the presentations are done, to also affiliate with one of the other panelists. So we're going to see where people-- how they cross over and how they perceive one another.
So, very complicated. And I had to beat them into submission, to get them to agree to do this. But they seem to be willing.
So let me provide these the bios for these individuals, who are-- we could write a book about each of them, truly. We're going to start with Naomi Sachs, who's closest to me, here. She's founding director of the Therapeutic Landscapes Network, co-author with Clare Cooper Marcus of the recent book Therapeutic Landscapes. She's also editorial assistant for Health Environments Research and Design. She has a master's in Landscape Architecture from U Cal. Berkeley. Currently a PhD candidate at Texas A&M. And she's developing a standardized tool kit for evaluation of gardens and health-care facilities.
And one of her original career ambitions was to be an aerial photographer. All right? So you know about Naomi.
Alan Dilani, Professor Dilani, Dr. Dilani is founder of the International Academy for Design and Health, also the journal World Health Design. He has a Master of Architecture from the Polytechnic of Turin, Italy, a PhD in Health Facility Design from the Royal Institute of Technology, in Stockholm. And he's done a lot of research with the Karolinska Institute involving salutogenic design, which he'll describe.
He's going to be retiring to a little place called Cap Martin, near Monaco. And evidently it's a very beautiful place. So, something about him.
Jennifer. She's a leader in health-care design at Shepley Bulfinch Architects. She specialized in master planning and health-care programming. She's had many clients, including entities such as Duke University, Banner Health, Yale New Haven. She's been on the board of the AIA Academy of Architecture for Health. She has her bachelor's fromAmherst and a Master of Architecture from Princeton.
And she gave me a short life story. When she was five, she didn't want a job. When she was six, she wanted to be a librarian. When she was 16, she wanted to be a neurosurgeon. When she was 24, she was going to be an acquisitions editor.
When she was 26, she doesn't want to be an architect. She wanted nothing to do with health care. And, in the last 30 years, she's been a health-care architect.
And Lance Hosey, at the very end, here, well known to those of you who are interested in eco-effective design sustainability. He was design director with the green pioneer William McDonough. And in 2015 he became the first chief sustainability officer with the international architecture firm Perkins Eastman.
He has degrees from Columbia and Yale. He's a fellow in the AIA and LEED. His books include-- this is an opportunity for me to sell people's books, too, right? --The Shape Of Green and Women in Green. Leonard Bernstein once kissed him on the face.
And he plays the saxophone. He says those two things are related. So, now you have a few critical insights into these individuals, I'm going to give them each a chance to say some more about what they're interested in. But before I do that, just based on that evidence, here's Naomi. Who-- landscape architect--
NAOMI SACHS: I'll close my eyes. [LAUGHS]
MARDELLE SHEPLEY: There's someone--
NAOMI SACHS: Aw. My husband is waving his hand.
[LAUGHTER] That's all I care about. [LAUGHS]
MARDELLE SHEPLEY: All right. Alan! Four, six. A few people.
LANCE HOSEY: He's retiring to a beautiful place. What about Jennifer-- [INAUDIBLE] if you vote for Alan, you may get to visit him in Monaco.
NAOMI SACHS: Yeah, right?
MARDELLE SHEPLEY: Too late! We've already moved on. Jennifer? Yep.
LANCE HOSEY: Can I vote? I'm sorry. I'm swaying you.
MARDELLE SHEPLEY: And Lance.
LANCE HOSEY: Leonard Bernstein kissed me on the face, [INAUDIBLE].
MARDELLE SHEPLEY: OK, how many people here voted twice? No.
MARDELLE SHEPLEY: All right. So keep that in mind. As they start talking about their area of interest, see if you change ships. In some ways, I hope you do, because what we're really trying to do is create this transdisciplinary outcome, based on the multiple professions that are out here and about in this particular conference.
So, just out of curiosity, who here is an architect? Oh, so that's a lot. So we have, like, maybe 10 or so. But those of you who are not architects also found common ground. So I think that's going to be the case, from here on in. That's how the world is going to turn.
All right. So we'll start with Naomi. And she has someone up front who is going to keep track of her time. And I'll follow up on that. So, Naomi-- your 15 minutes.
NAOMI SACHS: Thank you. Can you all hear me OK? OK, great. Well, Mardelle, thank you for the introduction and also the invitation to come here. Thank you, everyone who's worked so hard to put this conference together. It's been fantastic. And I go to a lot. I'm a bit of a conference junkie. so this is--
It's a really interesting blend, to think about hospitality and health care. When I told my mother about this conference, she was like, I don't understand how those-- what those two have in common. And she lives at in a continuing-care retirement community, so she knows a thing about hospitality and sort of health care. And so I think that if she, who knows about health-care design, can't immediately make that connection, that's a really good indicator that what we're doing here is an important thing that needs to happen.
So, it's a little after 4:00, and you've had a long and productive and fruitful day but perhaps are feeling a little tired, at this point. And I'm not going on any slides, because I used up all my slides earlier today. [LAUGHS] So I'm kind of winging it. I've become a little bit dependent on PowerPoint. So, I'll try not to get too punchy.
But I'm going to ask you, without falling asleep, to close your eyes for a minute. And imagine paradise. Whatever comes to your head, when you think of paradise. And then, imagine a restorative garden. Maybe it's the same picture in your head as when you were thinking about paradise. Maybe it's an altogether different place.
Now imagine a healing garden. Maybe that's the same. Maybe they're all the same. Maybe each one is different.
So, now, open your eyes. Or you can keep them closed, if you want. Of what you pictured above, how many of those settings do you imagine could take place in a hospitality environment, like a hotel, or a spa, or a resort? At least some of what you pictured probably could take place in some of those.
What about in a health-care facility? What about in a hospital, or a hospice, or an assisted-living facility? Were any of the environments that you pictured something that could easily fit or could sort of be wedged into a health-care environment? And you don't have to answer me, but that's something that I think we're facing in the health-care sector, is how to create environments that are places of healing and places of health and wellness that remind people of paradise, or a restorative environment, in some way or another.
So I'll start with my definition of a couple of different things. The first is landscapes for health, or also what are called "restorative landscapes." This is a very broad definition. It's my own definition. If you google the same term, you'll come up with different definitions.
But a landscape for health is any environment, wild or designed, large or small, even indoors, maybe even this, or outdoors, that facilitates human health and well-being. So, it is probably one of the landscapes or maybe all of the landscapes that you imagined. It could be Central Park, it could be Zion National Park, it could be your outdoor terrace with a few plants on it.
And then a healing garden is, in my definition, a hospital healing garden, or a health-care healing garden is a garden that's designed for a specific patient or resident population, with a specific intended outcome. And that outcome could be stress reduction. It could be rehabilitation. It could be socializing, exercise, et cetera. But it is designed, hopefully based on research, on evidence, with the practitioners who are going to be caring for the people, and hopefully also with the patients, for that intended outcome.
So, when we talk about landscapes in health care, we're usually framing that idea in terms of health. What can the landscape and gardens and plants do to facilitate human health and well-being? And we talk a lot about stress reduction, because generally, in-- and I'm going to say "hospitals," but I'm talking about broader health-care environments, as well. It's just I usually default back to hospitals, because that's where my main area of expertise is or my main focus.
Hospitals are really stressful, whether you're a patient-- you're sick, you're in pain, maybe you are getting diagnosed, maybe you just got a bad prognosis-- or you're a visitor, or family member. And you're worried about your father, your mother, your child, your aunt. Or you're a staff member or a care provider, and you're up 12, 13 hours a day, and you're walking 10 miles on your shift and you're making life-and-death decisions.
So, for everyone involved, it's very stressful. And we're designing for this very vulnerable population, often the frailest of the frail. So, we're talking about stress reduction, and how can the landscape reduce people's stress and make people feel better. And that's really where most of the research is, both around health care and around disadvantaged communities. Basically, how can nature make people's lives better-- make it a little bit better, or somewhat better?
In hospitality, people get to figure out how to make people's lives awesome. Right? It's not just a little bit better. It's like, I'm already well, I'm healthy, I'm on vacation-- yeah!
And so we're coming from sort of different places. And when we're looking at the hospitality model, I think there's a delicate balance that we have to find, between Disney and the Ritz Carlton and a casino or a resort and something where people are taken seriously. In some ways, some people would think of health care and hospitality as almost antithetical to each other, because one is serious, one is medical, and one is about fun and health. I mean, like, wellness, in a more positive-thinking way.
I think that we're the landscape comes in, for both of them, is it's a normalizing environment. So, in health care, where, like, in a general hospital, it's a very alien place, for people. It's a stressful place.
Everything is clean. Things are shiny. It's a sterile environment. It's an alien environment, for many people.
And so, to be able to look out the window and see some green and something that might be somewhat similar to what you see at home is very reassuring. To be able to even have that visual escape, and then especially to be able to have that physical escape, to go outside, to feel fresh air. When I do surveys, the most common reason that people say that they're going outside to the garden is, quote, "to get fresh air," unquote.
And that's somewhat about actually getting fresh air, even in maybe New York City, where the air's not so fresh. But it's also about getting a breather. Right? You know, "that person is a breath of fresh air." So it's an escape.
The landscape is also the first thing that most people experience, when they enter into wherever it is, whether it's a hotel or a resort or a casino or a hospital or assisted-living facility. And if that landscape is telling you, you're going to be taken care of, you are going to be honored as a person, look at all of this beauty around you, that's a really positive sign. And if your experience from when you drive in or walk in or take the bus in, all the way to the entrance, is led through the landscape, by shade and greenery and beauty, then you are so much less stressed when you get to the front desk.
And if the landscape is successful, there may not even need to be wayfinding signage. You don't have to worry about that. Because the landscape has seamlessly taking you there. So I'm talking more about the landscape as a whole thing, the whole site. I'm not just talking about the healing garden that is stuck in the little courtyard off the cafeteria-- although that's important, too.
So, sometimes we can even talk about the landscape as an aesthetic placebo. Although it's not a placebo, because it really actually does do something. And then someone brought up, in a talk earlier, that the opposite is also true. Right? A great landscape is a really good cue that you'll be taking care of.
But god forbid there's a bad landscape. You come in, and there are dead plants, and there's trash everywhere, and nothing's mulched correctly, and you don't know where to go. Is that how they're going to take care of me? Is this the kind of attention that I'm going to get? So, maintenance is also a really important part. So that, whatever landscape is there, whatever garden is there, has to be kept up all of the time, so that everyone is reassured.
Derek Parker who won the Changemaker award a couple of years ago at the Center for Health Design, when he was giving the presentation to-- he was having a conversation with someone. And they asked him about this new development of hospitals taking the hospitality role and becoming more about hospitality. And he said, I'm a little bit uncomfortable with that. Because, in general, when the customer-- right? --the patient, goes to a hospital, they don't want to be there. They're paying for a service that they really wish that they didn't have to have.
And that's a critical distinction that we really can't forget. Because we as designers have to take kind of a Hippocratic oath to do no harm. We have to keep in mind, all of the time, that yes, we are trying to provide pleasure, even, and solace and a sense of health and well-being.
But this is a population that is different from just someone on a family vacation. And I think, in terms of gardens and design in hospitals, we have to think about safety in a little bit different way than we would at a hotel. For example, you know, surfaces have to be smooth. And there has to be a really good balance of sun and shade. There has to be sufficient seating, outdoors and indoors, that's comfortable. So everything has to be designed to best promote whatever outcomes need to be there. So, as I said, stress reduction and health promotion.
And I think, also, what I haven't heard so much, and what I'm hoping to hear, in this conversation and in the other parts of the conference, is not just what hospitals and health care can learn from hospitality, but also what hospitality can learn from health care. Because I think in health care, they're doing some things really right, too. And Upali mentioned, in the first keynote, about the complexity that health-care providers and designers have to deal with on a day-to-day basis, and that intensity.
Another thing-- and I think Alan will probably talk about this-- is wellness. And, you know, hospitals in general are a part of the community, and they're really rooted in that community. And we're seeing much more of a drive toward not just patient-centered care and family-centered care but community-centered care and wellness and, you know, nutrition programs and farmers' markets and even food being grown on site. And that's something that health-care facilities are really in a much better position to do. So I'm hoping that there can be a two-way learning, as well. And I think that's it. Thank you.
MARDELLE SHEPLEY: OK, thank you.
Alan. Are there, first of all, any questions for Naomi, before we move on? OK. Thank you.
NAOMI SACHS: Everyone's still off in their paradise. [LAUGHS]
MARDELLE SHEPLEY: Alan, it's up to you.
ALAN DILANI: Oh. Well, thank you very much, Mardelle, for arranging this conference. And thank you also for Cornell University, to challenge this issue, hospitality with health-care design. Is first time I am dealing with this kind of conference, but I think it's very promising. We should start somewhere, and this is the first time that we see health care with hospitality.
I know Mardelle since more than 20 years. She is very prominent researcher in this field, and she has been always with us, worldwide. And, coming to Cornell, I am sure that contributing to this interdisciplinary faculties bring new changes and I am sure is bring new research in this field and contributing to the field of design and health and hospitality.
As Mardelle mentioned, myself, I am architect background. I went medical university. I did my PhD on public health, at Karolinska Institute, at my developing research in the field of design and health. So, we have developed our network Design and Health research center, but worldwide, as International Academy. We have organized several world congress in US, in a few years ago, with Harvard University, together with actually Texas A&M and Karolinska Institute, almost 20 years ago.
So, we're developing this field interdisciplinary. And, as Naomi had mentioned, and others, health is very complex. And we need more interdisciplinary approach to this issue.
I brought some brochures for you, if you are interested, for the next congress that we have, in Vienna, Design and Health. Mardelle is one of the person that's sharing scientific committee with us. And also international academy awards that we're dealing with every year. Many project we receive, and we evaluate anonymously, and we give the prize.
So, we put all this information on our website, designandhealth.com. And is available all our journal, more than 300 articles recently published in, is available. Design and Health is a knowledge community that belong to everyone, to participate with us. We have 18,000 members, active, 11,000 worldwide. We are working with ministry of healths around the world. We are working with university and with industry-- several industries here. they have been our corporate membership and supporting us.
This is a briefing brief of design and health shortly. But the main interest for me is health and design and the interaction between built environment and health and how we apply this knowledge. In health-care design, we have applied, but also we are interested, really, to bring to other discipline, to other area, like built environment for hospitality, for school environment, or elderly care. We have applied for prison design. We have done a lot of research in this field.
Our point of [INAUDIBLE] is health is very simple. We can say the definition of health, according to World Health Organization, health is "a state of complete physical, psychological, and social well-being." These three dimension of health is very important, and how to deal with this through the built environment, how we link the quality of built environment to these three dimensions.
And that is, first time, Aaron Antonovsky, he developed salutogenic approach to health. He criticized medical science, for first time, that medical science is too much focus on diseases and symptom of diseases and causes of diseases but really not working on health and promotion of health and prevention. That was in 1960s, actually. And wrote a book Health Coping Stress, was the point of the process for a critical review of health around the world, and also developing salutogenesis.
By "salutogenesis," means simply-- "saluto" means health, and "genes" means origin-- origin of health-- what make people healthy. And he developed salutogenesis by defining, each of us, we have our sense of coherence, capacity determined to manage stress. His point of the process was stress, and how to manage stress.
And salutogenesis is simply have three component, that whatever we do, we should understand, first-- understandable. And second component, manageability. We have enough resources to manage our task-- manageability. And the third should be meaningfulness. The life is worth to fight for our task to challenge for our task to reach our goal and kind of rewarding for our brain.
And these three components, each of us is dependent on how we have growing in our background an environmental area and environmental influences and our experiences in life, to determine the capacity to manage stress. We can measure, actually, the sense of coherence of each of us, and we have done a lot of work in this area.
There is also now is the HPH, Health Promotion Hospital and health services, to certify salutogenesis hospital in the world, who are focusing on hospital, how to focus on prevention, health promotion, and certify salutogenesis hospital. They have their 25 world congress, next year, in Vienna. They have been last year in Chicago.
So there is movement within the health-care industry, also, among the physicians, to work on health promotion and prevention. So this isn't a disciplinary approach to health. And architects, through this knowledge, could really design built environment that how coping with the stress and promote our health and well-being.
We look also to stress theory. And stress theory is also develop 1972, by our professor from Karolinska Institute, Lennart Levi, who is now a member of parliament. His point of departure for defining stress was built environment, architecture that creates social organization and function in our society. Which develop a combination of psychosocial [INAUDIBLE] from the built environment, together with biological program in our body-- tension, heartbeat, and blood pressure-- that this create a mechanism that we call "stress" and is developed as approaches to precursors of diseases and diseases itself.
So "stress" he defined as a process which interaction of the built environment-- architecture. And it depends also of genetical factor of each of us and earlier environmental influences, how we manage stress and how we interpret the environment. So I have this presentation, tomorrow morning, with slide and show example of how look like those design factor within the built environment that could prevent stress, that could promote our health and well-being.
So, this-- and how to interpret salutogenesis in relation to health care, we can link to hospitality. Yes, there is a lot of similarity. Within the health care, we need-- actually, we're finding we need welcoming environment that attract us. We need art, we need psychosocial factor, we need music, we need nature. We need all those factor that missing in many hospitals. Because of lack of interdisciplinary approach to hospital design.
When we design a zoo, as architect we do not understand how animals associate with their environment, how to sleep, how to eat, so we involve many discipline. But ironic, actually, we don't ask other disciplines when we design hospital. And those architect firm that they have interdisciplinary approach to hospital, they equally bring all this knowledge. And they are very successful in their work. And we have many examples, and we give academy award-- five to seven academy or some hospital, because designed by interdisciplinary approach.
I have, my experience, I have never hospitalized in my life. And I have never used any drug. And, in this country, as you know probably, we spend $5 billion each year for advertising drug. Which, in our country, is forbidden.
In our country, we focus on health promotion, prevention, and salutogenesis is well established-- in the entire Europe, actually, almost, especially in Scandinavia. But I must say, I am very familiar with all hotel around the world, because, for the last 20 years, I fly more than 120 flight per years. And I experience all kinds of hotel, from Ritz-Carlton to all three-star hotel, everywhere. I know very well.
And many times in my life, I wake up in the morning, I don't know where I am. And believe me or not, one of the most sophisticated hotel, Sofitel hotel, five-star hotel, designed hotel, in Vienna, they bring me there, they say, this is design hotel. But when I arrived in the main entrance, I see the only color, black. Entire main entrance is black.
I recommend you, if once you are in Vienna, you can visit this hotel, because it's Jean Nouvel from France. He designed, and he considered one of the most important hotel. But, by our knowledge, we can never accept this kind of environment as hospitality. Because there is no attraction. And we can see, also, in many entrance, there is a bar, but there is no people there, never.
And when I went to Reception, they asked me, do you want a color, black or white, I say, what that means that? There's only two different color in the room. I said, OK, obviously white color.
So I show you, tomorrow, this picture. When I wake up in the morning, everything is white-- floor, ceiling, and wall is all is white color. And as you know, probably, many of you, we lose the perception of space within 60 years. We lose this perception of the space. And by single color, we lose definitely this perception much earlier.
So, when I wake up, I didn't know where I am. So, it's for a few seconds, actually, I thought maybe I am in other planet. It's just white color. It's simply-- it's so strange for me.
So this is very famous architect. He designed these rooms, this hotel, but only with single color. So, because of the lack of interdisciplinary, the lack of knowledge, but still we see a lot of similarity between. And we can contribute to both of them, and we learn from each other.
And tomorrow I present this knowledge more with slide, example, to show you how design hotels in relation to hospitality. Thank you very much for your attention.
MARDELLE SHEPLEY: Does anybody have a question? Or was it totally clear-- totally black and white?
No questions for Alan? OK, we'll get back to that. All right-- Jennifer.
JENNIFER ALIBER: Thank you, Mardelle. When Mardelle-- and I should say, Mardelle Shepley and my firm-- not that I own it-- well, a chunk of it, but-- Shepley Bulfinch are not really related. This is not nepotism in action.
She said, so, just show some of your work and how you think about design. And I'm going to do a tiny little bit of that. But I want to use this as an opportunity, it's been a good opportunity, for me to think about how I think of hospitality and health care. And they're certainly related.
For those of you who don't know how architects get work, we are a nominally for-profit firms. And I say "nominally" because architects aren't typically great with money. We have to go pitch. We have to go interview to clients and persuade them that we are the best match for them.
And about 10 or 12 years ago, I flew from Boston to Chicago. We had an interview the next day, for a new hospital outside of Chicago. And that's a pretty good project.
And we were meeting our associate architect and the engineers. And it's an ugly day or two of trying to figure out what to put in the presentation. And, boy, that guy can really not present. So, even though you were going to give him six minutes, he's down to two, and you have to script him. And somebody else is wonderful that you didn't expect. So, you're doing all that sausage-making.
And that night, I went to the hotel that my travel agent had booked for me. I never heard anything about it, just showed up. Not very interesting, from the outside-- looked like a downtown office building. And I go up to my room.
And there, on my pillow, no chocolate-- a Granny Smith apple. And I was so delighted. I was so engaged, because it was so resonant with their brand, about caring about me. So it was unexpected and delightful and delicious.
Although I didn't know that until the next day, because I brought that apple with me to the interview and said you, client, you need to do a little bit of this, too. You need to engage your patients, customers, your workforce, in a way that's resonant with a brand about health and being healthy. And we did get the job, but I don't think it had to do with me and that pitch, particularly. But we're going to keep apples in mind.
So, when we think about the ends-- and I'm going to say, they're not necessarily diametrically opposed, but, for the next two minutes-- hospitality, high-end, Ritz-Carlton. And has anyone not been in a hospital design in the last 15 years? OK.
So, you probably think of it as this endless, white, sterile, disgusting corridor. Well, I shouldn't say "disgusting," but not a very hospitable or humane place, which, as Alan said. Actually, the Cleveland Clinic, their interiors, you can have any color you want, as long as it's white. So they probably have a little lesson to do. And I've never worked for them and, with a comment like that, undoubtedly never will. Oops!
But I do-- I'm a little bit in Derek Parker's camp. I'm not convinced these things-- the hospitality world and the health-care world-- they are not the same entity. And it's not just because I don't really want to be in a hospital-- unless I'm having a baby. That's probably the one time that I'm eager to get that little critter out and go home.
But they're very different, in lots of ways. Control is one of the big things. As the customer at a hotel or a resort, I get to decide almost anything I want to do and linger. In a hospital, I get decide virtually nothing. And all these people I don't know are coming in my room and talking to me about stuff I probably don't even understand.
And then the other part I really want to say is, I don't care whether we call them "patients" or "customers," but we have two-- in designing health-care environments, we have another customer base, and those are the clinicians. And if we focus only on the patient-- and, frankly, I think we've been slow to focus on the patient. But we have those two entities, and they both matter. And we have to respect them both.
So let me just go through this. I actually think, on the inpatient side-- meaning, when I'm in intensive care, or a patient bed-- those hospitality issues and things about the patient experience are interesting, but I don't think that's where the action really is. I think the action is going to be more in the ambulatory and outpatient environment, which is much more retail. So actually, I wouldn't limit this discussion just to hospitality. Because my expectations, as a customer and a consumer, are about all my retail environments.
So, whatever the airline does best-- and that's typically telling me my flight's delayed, but I get that on my smartphone-- I want my physician to tell me the same thing. So, that's my mindset, again, as a consumer, when I am sick and really ill and I am really worried about a cancer diagnosis-- again, and I wish Dr. Steel were still here. Is he still here? He was great-- for those of you who didn't see him in the last session.
I will do almost anything you tell me to do, if you're going to save my life. I don't care what the lighting's like, I don't care if there's a plant, I don't care. I just want you to save my life.
But, when I am going to see if I-- did I-- you know, did I break my hand or not? Then I'm really picky about how quickly you see me and how well you treat me, because the stakes are different.
I also think, as we move to a value-base population health model, we are on the edges of seeing some really, really interesting changes in delivery of care. There've been a lot of hotels often built near hospitals, with the idea that a patient would go there to recover, and virtually none of them has been as successful as I think people had envisioned. But now, when it's going to be in the best interest of your insurer, those models may change. And certainly outside the US we're seeing some of these cases.
Why wouldn't it be cheaper, if I am a-- my second day of recovery for a knee replacement, to go to the Fairfield Inn across the street, and there's a nurse there all night, and she or he can oversee 20 of us, if need be. That's got to be cheaper than having 20 home health aides. So I think we're going to see some really interesting models like that, and a lot of entrepreneurial models.
The other thing I really want to talk about-- when I mentioned retail, I think the issue of brand is really interesting, as we move to systems. When there was only one hospital in town, who cared? It was the hospital in town. Or maybe there were two. But when we got to talking about health-care systems, with multiple hospital locations, multiple ambulatory care, the issue of brand and brand identity and brand loyalty becomes very important. So let's just go through this.
When Mardelle did the little intro, she said I'm a programmer and planner. That means I'm the one who really-- I'm the one who tells the client that they need more space than they think, which means they either need more budget than they think or they're going to build less space than they think. That also means I'm actually not that interested in lobbies. I'm interested in how the ORs work and the ED. And, in my very selfish view, that lobby is just thousands of square feet that could be better used as something far more interesting.
That said, for most patients the lobby, the parking experience, the walking through that entry is the proxy for the quality of care. Because I didn't have time to look up whatever disease I think I might have. Well, I probably did on Google, and I'm terrified. But I probably didn't choose where I'm going, too much. So it's that lobby that's going to tell me this is a place that will take care of me. Dead plants might tell me it's a place that's not going to do such a good job.
Are people familiar with Banner Health? 30-hospital system, based in Phoenix. Really terrific system. They're one of the only systems I know that think about brand as more than a logo. And they have not only a set of kind of criteria-- things like onstage, offstage, how they deal with landscape-- but also materials. So that, if you were driving by Phoenix, you will recognize a Banner hospital, and you will know it's not Mayo, and you will know it's not Dignity. You will know it's Banner
And this is a couple things. One, it tells me I can go to that place. But the other part of that is, they use templates and models for departments. That means they can standardize. That means they know exactly how many employees should be able to handle care for these populations, and they can move their staff from place to place really easily and not have them go, oh my god, I'm in the right-handed room or the left-handed room. It is much safer for patients, and it's much more efficient and comfortable for staff.
So I've been kind of shocked at how few systems think in a standard way about space. And does anyone know about Bronson? One? OK Bronson is in Kalamazoo, Michigan. And I think it was one of the most fascinating case studies of a health-care provider, that I can think of, in the last 20 years.
Kalamazoo is a small Midwestern town that most of you haven't heard of, other than thinking it's spelled in a weird, funny way. In the early 1990s, they realized they needed to build a new hospital, because the one they had, like most hospitals, was a bunch of buildings stuck together and you couldn't get there from here. And they needed to redo it.
Unlike many of their peers, they understood the opportunity to redesign and to build a new hospital was the opportunity to transform the delivery of health care. And they knocked it out of the park. And, in this case, they focused primarily on the patient and family experience.
1995, 1996. It's a long time ago. And the fact that somehow these lessons haven't been fully learned puzzles me. They were a winner of the Malcolm Baldrige Award for quality. So they got the quality thing right, long before most hospitals and health-care systems could really say, that is our number one-- you know, quality is job one. It's Michigan. And maybe some of that was in there, too.
They were also one of the first Pebble Projects. So they did some of the initial research on infection control and private rooms. They nailed it, in a way that is just unbelievable, to me. And now they are in the healthy, living campus business. They are committed to the community of Kalamazoo.
On their campus, they've given away quite a lot of acreage to Kalamazoo Community College. And to think about food-- not just growing it, not just a farmers' market, but teaching people how to be in the food business so they can have a job. Because if they have a job and an education, they will be healthy. So, when Bronson plants a bush, it's a blueberry bush. And when they plant a tree, it's an apple tree. So that's where I think the future of health care and hospitality and retail and health is really going to be.
MARDELLE SHEPLEY: Any questions for Jennifer?
All right. Lance, thank you.
LANCE HOSEY: Hello. I'm Lance Hosey. I'm an architect and chief sustainability officer with Perkins Eastman. We are a global design firm. We focus on a lot of the different building types that we've been talking about today-- health-care, hospitality, senior living, et cetera.
So, as we talk about promoting health in the built environment, there's been a flurry of activities in recent years. And that's exciting and necessary, but-- am I using this, here?
MARDELLE SHEPLEY: Either way.
LANCE HOSEY: At the same time as we're doing that, we see a lot of overinflated claims such as these. "Healthy is the new green." "Wellness is the new green." We need a new vision of the built environment around the idea of promoting health and well-being.
But, as I tweeted last December-- what? This is the wrong-- I think we might have the wrong presentation, here. This is the revised one?
MARDELLE SHEPLEY: It should be the right [INAUDIBLE].
LANCE HOSEY: OK. All right. OK! I think we've got the wrong presentation, but I'll wing it. So--
Wellness is not the new green, it's the old green. So the oldest program in the building industry dedicated to sustainable design-- it's called "revised." Is that the only one?
MARDELLE SHEPLEY: No.
LANCE HOSEY: Sorry! I usually bring sock puppets for this sort of moment, just to keep everyone entertained.
MARDELLE SHEPLEY: How do I get to the, uh-- to the Desktop? Do you use Macs?
LANCE HOSEY: I don't use Macs. Is there a Mac expert here?
MARDELLE SHEPLEY: No, No this isn't a Mac. We're going to go back to the Desktop. So you've got two presentations. One has a few fewer slides. And so I'm just trying to get back to the Desktop, to see if it's sitting on there.
LANCE HOSEY: Sorry!
NAOMI SACHS: Does anyone have any questions, so far?
LANCE HOSEY: There you go. I was going to go into a rendition of "I've Got a Gal in Kalamazoo, while you were sitting there, but I thought that wouldn't go over well.
JENNIFER ALIBER: Don't you want to know what hotel brand gave me the apple? Yes! Who do you think it was?
LANCE HOSEY: All right. OK.
JENNIFER ALIBER: Got it!
JENNIFER ALIBER: Kimpton.
LANCE HOSEY: OK, sorry about that. This is where we were. A lot of proclamations about health and wellness being the new green. And here's the missing slide. As I tweeted last December, wellness isn't the new green, it's the old green.
The oldest known program in the US dedicated to sustainable design is the American Institute of Architects Committee on the Environment, on whose advisory group I currently sit, founded in 1990 by Bob Berkebile, with BNIM, and a number of others. And one of the things that led to the founding of COTE was the idea that buildings are making us sick. A decade later, the general media routinely covered sick-building syndrome. This was 15 years ago. This arguably, SBS, is one of the reasons why the sustainable-design movement, the green-building movement, really grew in the first place.
So now, when we talk about sustainability, we think of it very narrowly as being about environmental value. The original thinking was the integration of social, economic, and environmental value, all at once. Another way of looking at this is social, economic, and environmental health. Sustainability is about health.
Now, when you break this down, you can look at public health, personal health and well-being, physical, mental, emotional, as we heard a minute ago. Those are social values. If I asked any one of you to tell me what you value most, you might say friendship, love, family. Those are also social values.
In fact, fundamentally, the idea of society is promoting health and well-being. So, another way of putting this is really that sustainability is about everything. And yet, one of the most common things I hear from my peers and colleagues is that their clients don't care about sustainability. And if sustainability is everything, then, when you tell me your clients don't care about it, what I hear you saying is your clients don't care about anything. It's just not true. Our job as designers is to understand where clients live, what they value, start from there, be as smart as possible in delivering that value while connecting it to this larger spectrum of value that we call the "triple bottom line."
Now, if you look at health care and hospitality, traditionally health care has embraced sustainability, or at least a narrow idea of sustainability, because the long-term value of it, as owner-operators of complex institutional buildings, has been pretty clear. But hospitality is one of those markets that is significantly lagging, around green building. This is from a study that ENR does every year of how much of architects' annual activity devoted to green goes into these different markets.
So, some of the reasons for this are, Cornell, here, did a study a few years ago that says that guests in hotels tend to perceive comfort and going green as being opposed to one another. We're sacrificing comfort, in order to conserve resources. As a result, one of the conclusions was, green is not a silver-bullet strategy.
So, if you look at that, we think about the traditional criteria that we use to judge designs-- cost, function, and aesthetics. And occasionally we'll throw this additional criteria in, sustainability, on top of it, as if it's somehow separate from and independent from these other questions and it's instead-- what I'm proposing is, we think of sustainability as the way that we look at these other questions. It's the lens we use to make smarter decisions.
In other words, it's not a silver bullet, it's the only bullet. So the only way to look at how to provide value. And the basic question we ask is, do we want to be smart, or do we not want to be smart?
So, if we go back to this idea that comfort and going green are somehow opposed to one another. Cornell did a follow-up study that shows that hotels actually are improving the bottom line by going green. So let's look at those three different value areas.
Environmental value, going green; social value, comfort; economic value, improving the bottom line. The question is, what strategies can we employ, as designers and architects, to promote all of these at once, rather than thinking of them as separate from one another?
So, the process that we call "integrated design" starts, first and foremost, with the goals and values of the clients and communities we serve. What are we trying to do? Then we figure out the smartest ways to accomplish that. And, importantly, we evaluate the results. If we don't look at what actually happened-- did we meet our goals or not-- then we're just making it up.
So, look at hospitality again. This is a project that Perkins Eastman did, in Portland. So, if a goal is to enhance comfort, there's abundant research that shows that designing with good daylight, fresh air, connection to the outdoors can improve satisfaction significantly.
Which also improves operating cost, because you're relying less on mechanical and electrical energy. You're obviously spending less on energy. Which also improves energy consumption, right? One strategy, value across the entire spectrum.
So, the basic question this asks is, what do we mean by "good design"? Jennifer and I were just talking about this. Designers and architects exist to produce good design. But if I ask 10 different architects to define good design, I might get 10 different answers. Because it's fairly mysterious. In fact, often we hire designers because we think there's some mystique involved in the process, as if it's magic.
Gary Hamel, whom the Wall Street Journal calls the most important business thinker in America today, says that "Good design is like the Supreme Court's definition of pornography. We know it when we see it." So, if we can't define what "good design" is, how are we supposed to practice and produce it? If, instead, we shift the idea of design away from the highly subjective and mysterious, and instead start to define it around objective values that we can produce, then we need to dive more into research and science about how people respond to different places.
So I wrote a book that came out in 2012 that, as far as I know, is the only book dedicated to the relationships between sustainability and beauty, which are things that we think of generally as being opposed to one or another. It asks the basic question, does sustainability change the face of design, or only its content? Conventional wisdom on this is clear. Some of the most celebrated designers in the world dismiss the whole agenda, because they think it has nothing to do with good design.
But, in fact, research shows that up to 90% of the eventual impact of a project is determined in the earliest design decisions-- what it's shaped like, how big is it, where is it located. And yet we think of sustainability and performance is something that lives in a technical manual, or in a sophisticated computer model.
So one way of looking at this is, there is a relationship between form and performance. Most of the designers you've ever heard of practice solidly in one end of this spectrum. Frank Gehry, [INAUDIBLE], people like that, get a reputation because they have compelling form without compelling performance.
The other end of the spectrum are buildings that, because they have smart materials and methods and systems, tend to perform well. But I think it's safe to say they're not very compelling architecture. This is what gives green building a bad name.
There's relatively few architects practicing in this overlap, the sweet spot in the middle. This is Norman Foster's London City Hall. It leans into the sun, minimizes its profile to the hottest time of day, in order to reduce heat gain.
In addition to that, how you basically shape a project, there is an enormous wealth of research, a growing wealth of research, around neuroscience and environmental psychology, into how shape, color, pattern, form, space tends to influence how we respond to a place. I recognize that an architect talking about science to a roomful of scientists-- I might as well be a monkey on a unicycle, but bear with me for a minute. This is why it's important that we all collaborate, so I'm not just making things up.
Now, raise your hand if you know the term "biophilia." Maybe half the audience? Which means that we have an innate attraction to, quote-unquote, "nature." Where that comes from is this idea of the savanna theory, the theory that comes out of evolutionary biology that the human race existed for the first 98% of its history in a very particular environment, namely the African savanna. So it stands to reason that, in the relatively short period since we left that environment, we've been seeking out the same environmental, spatial, visual cues we had in this place that was the cradle of the human race.
If you look at it that way, a golf course is a sanitized savanna. We like places that have gently rolling hills, little stands of trees, little bodies of water, et cetera. EO Wilson, who literally wrote the book on biophilia, says that "Beauty is in the genes of the beholder."
Now, most of the ways that architects and designers-- those relatively few who are familiar with biophilia-- most of the ways that they're embracing this research is to do what we did at the UCSF Medical Center at Mission Bay. I think Mardelle mentioned that I used to be at William McDonough + Partners. We partnered with Anshen and Allen, who's now with Stantec. This is the largest hospital in the University of California history. We developed it over several years.
And one of the fundamental ideas of it was this idea of healing gardens in a very urban environment. So, there are a lot of benefits to this. And it's a terrific thing to do. But it's also a fairly obvious way to incorporate biophilia. Right? People like green, growing things. Let's bring green, growing things into the built environment.
There are subtler ways to do similar things. This is a project that we developed for a large mixed-use development. And the idea is that it becomes this sort of artificial savanna, very porous between inside and outside.
There are even subtler ways. And I'll leave you with this last example. A lot of the research that shows that there are benefits to us being in, quote, "nature"-- and I throw "nature" in quotes because we tend to throw that word around, when most of the time that we encounter things like this, this is not nature. This is just picking up something that grows and putting it into a pot. Right?
So there's a physicist named Richard Taylor, in Seattle, who's done a lot of research into natural fractals, images like this, where things are self-similar at every scale, from the large to the small. And scientists classify fractals on a scale of 1 to 2, 1 being an open plain or the open ocean, 2 being a dark, thick forest. And what they find is that people tend to prefer this optimal density, right in the middle, about 1.3, 1.4, that feels a lot like an acacia tree that you might encounter on the African savanna.
And what Richard found, by doing skin-conductance tests and heart-rate monitors and such is that, by just being in people's field of vision, this kind of pattern can lower stress by as much as 60%. And he calculates that, because we spend about $300 billion a year combating stress-related ailments, in the US, that, by lowering stress, if you imagine that everything around you here isn't beige-- instead, it had all the same spatial qualities that we associate with these things-- but it's abstract and not necessarily the forest itself, that it could be worth nearly $200 billion in combating stress-related ailments.
So, there are a lot of architects and designers who are already playing with irregular patterns and colorways. For instance, Jean Novel's Louvre, in Abu Dhabi, looks like this. It feels like the forest canopy. I talked to their office, when I was developing my book. I asked them if they were familiar with this research around fractals. They were not.
So, the idea is, if we're already building something like this, and it were more informed by the science of this kind of research, how could we transform the built environment so that it doesn't just look good to architects and instead can be good for all of us? Thank you.
MARDELLE SHEPLEY: I think I'll leave this nice, green screen up behind us. We have about 20 minutes for questions. I have a couple that I can put out there, but I would like to open it up to the audience, first. So, who would like to jump in, here?
AUDIENCE: I have a question. [INAUDIBLE] So I just really am glad that you pointed out [INAUDIBLE] health [INAUDIBLE] are very much the same. And we are constantly challenged with [INAUDIBLE] energy versus [INAUDIBLE]. And so I just want to [INAUDIBLE] you were talking about that. [INAUDIBLE] we do still [INAUDIBLE] a lot. [INAUDIBLE] But I think we're getting into a degree of safety, more about the [INAUDIBLE] built environment. In fact, it's [INAUDIBLE] common challenge of [INAUDIBLE] of sustainability and health think [INAUDIBLE] about how those entities can even work more together.
LANCE HOSEY: Is that for me? Does this work? Can everybody hear me? Really, it doesn't sound like-- it just sounds like me. Hello? All right. That sounds like God.
So, generally speaking, remember that wheel that I showed, with a lot of different values, the spokes on the wheel being-- the idea of that, that we developed as a tool, is that that could have a dozen spokes. It could have an infinite number of spokes, depending on what the clients and communities that we serve care about most.
So, for instance, one of the most common markets that I hear clients dismissing sustainability in is the developer-driven market, where the idea is, some money-grubbing bastard just wants to spend as little money as possible to put a roof over his head. And we tend to dismiss that as an opportunity for innovation or sustainability or high performance-- anything. But there's plenty of research that shows that-- again, as I showed earlier-- that, if you rely more on free resources such as daylight and outdoor, fresh air, you can reduce the size of the mechanical and electrical system by as much as two thirds.
San Francisco Federal Building, for instance, thought of the passive design as a way of eliminating the mechanical system. Those same things also tend to promote health and well-being. So, if we're starting with someone who doesn't care about these things, as long as we serve the thing they do care about, a home run would be, give them what they're asking for and more of that, in a way that also connects to these other things. Right? So that's the sort of least-common denominator.
The other end of the spectrum would be-- I actually have found that the biggest challenge has been with clients who start with the things that you and I care about but haven't figured out how it is incorporated in their everyday practice. So, I think it's less about money and more about understanding people's habits. And, in fact, the only two things that I've ever found clients will object to are, do they spend more money, or they spend money differently than they're accustomed to, or do they have to behave differently?
The second thing is far more challenging than the first thing. You can always get around the money barrier. It's very hard to get around the cultural barriers. So, where we found some success is that, if you get to know people as a community and understand their habits and find the common ground that they all sort of inhabit, then you can build from there. Does that make sense?
MARDELLE SHEPLEY: Does anyone else on the panel-- like to comment on that?
NAOMI SACHS: Yeah, I'd like to comment on that. In terms of the well-being, and how sustainability and well-being are often not combined optimally, some of the best examples that I've seen, in linking those two, are actually in health. Clare and I, in the book, we wrote a chapter on the linkage between sustainable and therapeutic landscapes. And Kent Hospital, in Rhode Island, in Warwick, Rhode Island, is a great example, where they had reached their limit for their building, in terms of stormwater retention. They couldn't build any more. And so they had to create rain gardens and rooftop gardens, as a way to be able to expand their building.
And they decided, well, as long as we're doing that, let's make them healing gardens. Jennifer was talking about branding. So they rebranded themselves and created this whole brand on, we care about the patient, the visitor, the staff, and the planet. Everything that we do is about health for everyone.
And when you start looking at it that way-- you know, it's sort of like with hotels, when they say, oh, we're being so green, so don't use the towels unless you've used them, well, that saves them money! [LAUGHS] Because then they're not washing the towels as much. And so the same thing with health care. If you've got a green roof, or trees that are providing shade, if you've got less stormwater that you're having to deal with, in all sorts of ways it's taking care of everyone. That's a win-win-win situation.
And I think that goes back to this idea of the triple bottom line. So it's not rocket science. But, for some reason, we're still stuck in this, well, it has to be either this thing or this thing or this thing. And often they really go beautifully together.
ALAN DILANI: I just wanted to mention-- the definition of "sustainability," in the beginning, we link to use of energy. And then later on comes green building and all this, and then LEED, et cetera. In Europe, we have developed now energy index, for building. What means, actually?
Nowadays, we want to have really sustainability in the broader aspect-- what you mentioned, higher performance. But it should be related to health and well-being. We have discussed, our last congress, how we can develop health index of the building. And by "health index of the building," we means, really, interaction between the quality of our environment and performance of the building, in general, in relation to health and well-being of the users.
And there should be-- and really, "sustainability" means broader aspect, higher performance, in relation [? and ?] health well-being, and nothing else. Because, nowadays, ecological architecture, we have much more broader aspect of saving energy and consume of energy by Dr. Ken Yeang, who is the father of ecological architecture, he has demonstrated this for us. We can do much more. And not only saving energy and [INAUDIBLE].
MARDELLE SHEPLEY: [INAUDIBLE]
AUDIENCE: Yeah. Um, Lance-- and I think I'd build upon what Whitney said, with regards to the transformation, it's kind of the next step of sustainability. I think it's an expansion of sustainability. Maybe health has always been part of it. But I think more and more it's becoming a key component of it.
Dodge, and with Delos's support, just came out with a new report on data analytics about the drive towards healthier buildings in 2016. It's a great report. And it really does seem that sustainability's been great, and it's changed the way the world has built-- decided to build buildings.
I think that sort of the next step, next evolution of that is focusing on health. It seems like the market, the consumers understand it better, and that they're willing to pay more. And it's also bringing in people who-- it's a differentiator.
And I think that the LEED sustainability, for instance, has been so well adopted that it's no longer a big differentiator, where health is starting to become more of differentiator. So, I think that we're going to see more of that. And the research and the development of it is sort of taken a whole nother level of discipline, which I think is good for everyone. So, I guess I think that that's a trend that we're going to see build, more and more.
MARDELLE SHEPLEY: So it sounds like more of a comment than a question. Do you want to respond--
LANCE HOSEY: May I say a few things about that? Yeah, I think, Whitney, you presented this last week, right? Also, if you get a chance to ask Whitney how she feels about fried chicken, she's not big on fried chicken. So.
I'll say two things about that. One is, I think the language gets in our way. So I say "sustainability." You take it to mean one thing. And one of the things that a lot of people smarter than I am say is promising about the whole agenda that we put under that umbrella is that we can fill with meaning over time. But our resistance to pin it down has meant that people have made up their own ideas about what it is. It stands over here, and therefore we've got something new and shiny.
So, on the one hand, you know, I hear a lot of people say what you just said, which is that people have gotten tired of LEED, and we want something more ambitious. That is true of many, many people that I know well, because they're early adopters and they want to move beyond that. But LEED has certified less than 1% of the built environment. So, while those of us in this room are thinking about how to break new ground, how to sort of move beyond where the industry has been, because we're really eager to toy with innovation, the vast majority of what's being built isn't even scratching the surface of any of this.
American Institute of Architects, six, seven years ago, adopted the 2030 challenge around energy. And every year, they more than double the amount of square feet that are submitted for evaluation. So they went from a few million square feet to a few billion square feet, over the last handful of years.
The new report just came out, I think, last week. The industry has flatlined, six years in a row, at 35% energy reduction. We're getting no better at this. So, on the one hand, yes, I think it's exciting to think about innovation and what's new. On the other hand, are we taking care of what's old? Right?
So, if we think about-- I think this goes back to Whitney's question, right? If we think about how people who are looking for differentiation, how we can serve that by giving them more and more interesting things, because lots of people want to be pioneers, that's the very leading edge of the bell curve. What's happening to the rest of it? So, I just want to know how we're really kind of lifting all boats with one tide. That's a terrible metaphor!
AUDIENCE: Yeah. One comment, and then a question. The comment is related to this issue about the wellness and return on wellness. Tomorrow morning, in the 9:30 session, Min Kyung Lee, here, she is going to present some results which will quantify exactly how much customers are willing to pay for a wellness room, in a hotel, and exactly how satisfied they are with [INAUDIBLE] together. So, this is a little commercial for her session, but you may want to attend that, to have the answer.
The question is, all of you talk about new design, new buildings, new facilities. How about the existing hospitals and nursing homes and retirement communities and, you know, ER? What can we do to make them redesign for the better?
MARDELLE SHEPLEY: Who would like to answer that?
ALAN DILANI: Well, our experience in Europe, at least, in many old hospital, we recommend to demolish the entire building, because the running costs, three years' running cost, corresponding the total cost of the building. So it's very important, in relation to performance.
In Malaysia, we advised the Ministry of Health several hospital to be completely rebuilt after only a few years. Because the cost of running cost is almost two years' running costs, corresponding the total cost of the building. In some case, we find one year's running costs in the hospital is corresponding total cost of the building, which means--
In Europe, we have three, four years. In US, probably five, six years. So, it's always related to the performance of the building in relation to running cost. And how we improve it and the performance tell us very clear picture, if we should rebuild or entirely remove, actually.
MARDELLE SHEPLEY: Is there a question here?
LANCE HOSEY: Can I briefly say something about that? Sorry I'm talking too much, but. Yeah. So, do you remember, Jennifer showed you the shotgun corridor, hallway, double [INAUDIBLE] corridor, no windows? If you If you build a building like that, then, when it comes time to renovate it, even if you use the best materials, the best systems, and do all the smartest possible things, you're still left with the shotgun-barrel hallway. Right? If the bones of the building aren't designed to adapt over time, then all the pressure we're putting on buildings to be as compact as possible remove the likelihood that we can really sort of engage the outdoors. And that's a real problem.
Last thing I'll say, briefly, is, all buildings are existing buildings, just how long they've been existing.
NAOMI SACHS: I need to add to that. [LAUGHS] Because not all health-care facilities or all hotels can demolish themselves and build afresh. And so, don't lose hope completely, if you can't do that. If you don't have the budget, or if you don't have the budget yet, just in terms of from my perspective, providing access to nature, there's artwork. There are cosmetic changes that one can do.
There's organizational culture change that can happen. So, if there is a garden, staff could maybe send people to the garden! If it's not easily accessible, if it's on the roof and people don't know about it. So, you know, if you can't rebuild right away, all hope is not lost.
And it really depends, you know, what you want to do. Do you want to provide access to nature? Do you want to create more consumer-oriented, patient-oriented-- there's always something that one can do. And it really just means making-- starting that step and asking the questions and starting on that journey.
JENNIFER ALIBER: I would just like to add that a good, old building can be far better than a crappy, new one.
NAOMI SACHS: Yep.
JENNIFER ALIBER: And if we have clients out there, you know, invest in floor-to-floor height. You know, give yourself the bones to got the gosh-darned thing in 30 years. It'll be standing, but it's-- it's an incremental investment that will pay off for a long, long time. Especially in health care, where things want to be close to other things.
Imagine you're the patient on the stretcher. You don't want to be going a half-mile away. So proximity and adjacency are really, really valuable. You don't want to blow it.
MARDELLE SHEPLEY: Go ahead.
ADAM GRIFF: Hi my name is-- Hello, my name is-- apologize about that. My name is Adam Griff, Brightspot Strategy. Alan, I really enjoyed your comment about the sense of coherence and how to manage stress. And I heard a lot of conversation-- and, of course, this makes perfect sense-- about how to manage stress through the design of space.
But within health care, a lot of the stress comes not just from being ill but the administrative management of your care. Right? Managing the different doctors, the different physicians, managing that whole experience is really pushed on the patient, in a way that it's not in hospitality. In hospitality, it's actually the opposite. They take care of the logistics of the entire experience for you, so you can focus on being in that moment and paying attention to what's going on.
And so what can we, as designers, do-- and, in some ways, we may be limited as architects-- and I'm a former, recovering architect-- to deal with not just the design of the space but the design of the services?
MARDELLE SHEPLEY: Do you have a response to that?
ALAN DILANI: Well, in our culture, in Europe, we really consider more staff. Best hospital when you have best staff and best performance, and best healing outcome when you have best treatment. And that's why actually patients, just few days, in our case, but the staff is almost 20 years there. So we focus more on staff, as users, main user-- and afters, really, if I give priority.
so in relation to staff, we try to provide all this wellness factor that really could manage their stress. And there is many successful example in Europe, but also here, in Canada and US, we find that has this kind of approach. So they're coming, the service provider and all this organization, how we can put the salutogenesis and sense of coherence and [? major ?] sense of coherence of staff, but not patients, in order to manage stress and provide the best services.
JENNIFER ALIBER: So, I know, as a patient, what I would want to see. I would like a printed version, or a digital, of what's going to happen to me that day. What's going to happen at 7:00, what's going to happen at 9:00. Because the issue of uncertainty is such a driver of the stress.
Nobody tells you anything-- that, yes, there's a white board, probably, in the room that says you've got Nurse Nancy and, you know, Dr. Smith, but that's not enough. So, if we could manage to help patients think about their time expectations, that alone, I think, would be a tremendous relief, even if it changes. I always say hospital time is like molasses. Somebody will come in and tell you something's happening "soon." 20 minutes, or 5 hours? You know, and--
NAOMI SACHS: Depends how much pain you're in.
JENNIFER ALIBER: Well, yeah.
NAOMI SACHS: [LAUGHS] But they don't even know. I was shocked-- my first kid was a C-section, my second one was a stat C-section. I had never seen them move their butts so fast. I didn't even know hospitals were capable of it.
So, again, I do think time is the final frontier.
MARDELLE SHEPLEY: We'll take two-- last two questions, one here and one here.
AUDIENCE: Yeah. I'd like the panel to comment on-- you haven't mentioned about technology in improving the experience. Right? So, give you an example of-- the car now is a very personalized experience. You go in, you have your biometrics, you customize the environment to you. Right? So would you like to comment on that, for example? You know, if you are a Platinum member for Marriott, the only profile they did for you was, what room preference. I think they can do better than that. Right?
So, in your comment of design sustainability, what sort of role you see technology, which I haven't heard anything play in terms of efficiency, you know? Home network, where you go into the room, you can [INAUDIBLE] up the [INAUDIBLE] So, perhaps you want to comment on that.
JENNIFER ALIBER: Well, I would say there's been-- to me, there's been a sea change. Most of the waiting rooms that we design for outpatient care, 15 years ago were empty. Because our clients have gotten so good at actually learning how to deliver care when they say they will. On the outpatient basis. The inpatient's much, much trickier.
So a lot of it is kind of invisible. I don't know that we-- I don't think as architects we've done a particularly good job, in terms of technology that the patient gets to use, other than the TV. Now I can watch a-- you know, how to go home and clean my wound thing that-- you know, I am not watching that.
There's some children's hospitals that do a lot with choice. Now my room is blue! Now my room is yellow! I don't know, I think that would drive everyone nuts after about 10 minutes.
So I don't think we've been very good about it-- yet.
AUDIENCE: [INAUDIBLE] example as a consumer.
JENNIFER ALIBER: Right.
AUDIENCE: In the hotel against [INAUDIBLE] nice in my room to see what [INAUDIBLE].
JENNIFER ALIBER: Yeah.
JENNIFER ALIBER: Exactly.
AUDIENCE: Those are very fundamental.
JENNIFER ALIBER: Very fundamental. I don't think it's--
JENNIFER ALIBER: Right. I'm with you. And I don't think it's rocket science.
LANCE HOSEY: Can I say, briefly, on that, that-- so, I think it was Naomi, earlier, who made the point about-- we're talking a lot, all day, about health care learning from hospitality. What about the other way around?
I travel a lot. I spend a lot of time in hotels. And I can tell you, most hotels are really crappy designs. And it's the low-tech stuff I care more about.
So, for example-- I mean, I've stayed in hospitals. And some of them are actually-- if you're in the patient room, and you're not under critical care, it's something that's actually fairly enjoyable. Reason being that the designers think very, very carefully about every single aspect of it.
That is not the case with most hotels, because hospitality designers often are driven most, like most designers, by what they like. So a pedestal sink in a hotel room makes zero sense, because there's no place to put my toothbrush! My--
JENNIFER ALIBER: Or your makeup!
LANCE HOSEY: Or my makeup! And you know I wear the makeup.
For example, my biggest pet peeve is a shower that you can't turn on without being in the shower. So, yeah. So I think actually hospitality designers would learn a lot from going around and looking at smarter hospitals.
JENNIFER ALIBER: And I want a second glance on that. I was in Houston, a couple months ago, visiting-- interviewing, kind of-- polite interviewing of engineers and other co-consultants. So I had, like, three breakfasts, three lunches, and three dinners, all at restaurants or hotels. And the plumbing fixtures-- I felt like a moron, by the end of the day, because I couldn't figure out which sink is water sink or a--
LANCE HOSEY: But they look cool, don't they?
JENNIFER ALIBER: And they look cool, and I was just so frustrated. And I tested every single one. But the lack of-- I don't want to be outsmarted by my shower in the morning.
MARDELLE SHEPLEY: One-- please-- one last--
ELIZABETH WIENER: My name's Elizabeth Wiener, and I curate-- can you hear me now? My name's Elizabeth Wiener, and I curate art collections for hospitality and for senior-retirement facilities and some hospitals, primarily in Southeast Asia, China, and some in America. And my question is-- well I have a few comments, and then a question for Naomi.
Have you found that the curb appeal and the design of the gardens are more elevated in their spirit in Asia than they are in the States? And then my question to Lance is, I work on a lot of Half Century More projects in Japan. I've done 11 of them, over the last 20 years. And those are senior-retirement facilities in Japan that are very upmarket. But they rival hotel collections. Because when we did the Peninsula Hotel, in Tokyo, and we did the senior-retirement facilities in Tokyo, they were very much on the same budget and on the same program.
And in the States I find that the senior-retirement facilities, both interior and exterior, are not on the same level as they are in Asia. Another example would be Richard Meier's design for Camden Place hospital, in Singapore. And that has amazing gardens, amazing rooms, amazing public spaces, amazing art collection, et cetera. But it was really, really an experience to work with Richard Meier in that level, similar that, when we worked with Norman Foster, at Capella, in Singapore, it was a similar level. In other words, their anticipation, the client's anticipation, was very, very similar.
In the States, I feel that we may get some of that in hospitality, but we don't get as much of that in senior retirement. And I'm wondering, on your levels, on both design of interior and design of gardens, if you see it the same way, as this dichotomy, a cultural dichotomy, between Asia and the States. And in "Asia" I also include China.
NAOMI SACHS: Yeah. Unfortunately, I haven't traveled enough [LAUGHS] to Asia personally to be able to say. And I've looked at lots of pictures in magazines. But to really be able to say there's more of this there than here, I would be kind of guessing. So--
ELIZABETH WIENER: That's fair.
NAOMI SACHS: --I don't know.
LANCE HOSEY: I would say, briefly, that I don't do any senior-living work, but Perkins Eastman does a lot of it. And we do-- we've been doing work in Japan for 30 years, I think. And my understanding, from my colleagues who do a lot of that work, is that Japan is very serious about this, for two reasons.
One is that-- in terms of the quality of senior-living environments-- one is, Japan just has a better relationship with the built environment than the US does, in general. Longer tradition, a more coherent tradition. And the other is that they-- and this is shorthand, now-- seem to value multigenerational interaction more than we do here. So, we tend to not think very much about what happens to people when they retire. And, because we're so car-dependent in the US, they have no choice but to be dependent on facilities that are urban, suburban wastelands. Right? It's not true in places like Japan.
However, I wouldn't generalize to say that of all of Asia. I've spent a lot of time in China and other places, and China has a very different culture, in large part because, over the last couple of generations, China has really changed a lot, whereas Japan has a much stronger sense of tradition.
ELIZABETH WIENER: There's a huge cultural difference between these countries, and in America, as well.
LANCE HOSEY: Yeah.
MARDELLE SHEPLEY: I'm afraid we're out of time. You don't even get to find out who's [INAUDIBLE] to whom, up here.
LANCE HOSEY: Aw!
MARDELLE SHEPLEY: [INAUDIBLE]
NAOMI SACHS: I love all my co-presenters equally.
MARDELLE SHEPLEY: Right--
LANCE HOSEY: Yes.
MARDELLE SHEPLEY: [INAUDIBLE] everyone [INAUDIBLE] gets a sense that they share this common calling. And we appreciate your presence here. We have gift certificates. Thank you for--
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Panelists discuss the consideration of service and healthy living in design, Oct. 10, 2016 at the Cornell Symposium for Hospitality, Health, & Design.
Features: Mardelle Shepley, Associate Director of CIHF; Jennifer Aliber, Principal, Shepley Bulfinch; Alan Dilani, Professor, Architect/Public Health, International Academy for Design & Health; Lancy Hosey, Chief Sustainability Officer/Principal, Perkins Eastman; and Naomi Sachs, Founding Director, Therapeutic Landscapes Network.