HKS Health Fellowship

HKS Health Fellowship

The HKS Health Fellowship is a one-year program developed to propel talented recent graduates who are committed to improving health care environments through design. The fellow pursues research while working on design projects in our award-winning health studio.

The prestigious fellowship — open to applicants finishing their undergraduate or graduate studies — is much more than an academic opportunity to delve into a topic of choice. The winning applicant is given full-time employment at HKS and the opportunity to continue his or her career with the firm after the one-year fellowship term.

Fellows work with some of the most influential architects and researchers in the profession and have access to networking and travel opportunities.

The winning applicant is given full-time employment at HKS and the opportunity to continue his or her career with the firm after the one-year fellowship term.

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“The Health Fellowship allowed me to investigate a topic I was deeply passionate about. It opened doors within the firm and industry to connect with thought leaders and be mentored in healthcare planning, research, and design.”

Hannah Shultz, Medical Planner

How It Works

Each year, the HKS Health studio leadership and previous fellows assist the incoming fellow to develop a research topic. This topic will be based on the fellow’s particular area of interest and strategic initiatives within the HKS Health studio.

Suggested topics include, but are not limited to, the following:

The fellow will also get the opportunity to attend one health-related conference to support research and education, coordinated through the committee of mentors.

At the end of the fellowship, the designer delivers results, that may include, but is not limited to a research paper or a design tool. 

HKS leaders will work with the selected Health Fellow to pair them with the HKS office location and mentorship that can best support their research interests. During the interview stage, fellows can relay their office preference with firm leadership and discuss that office’s ability to support their research.

“We prioritize research in everything we do, and the fellowship infuses this mentality into a unique entry-level position. It’s creating the next leaders in our firm.”

Southern Ellis, Architect

Important Dates & Applying

Applications open
November 1, 2023

Applications close
January 2, 2024

Interviews via Zoom
Mid-January

Fellow announced 
Late January

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The Fellows

Kurt Chiusolo

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Towards Wellness in Design: A Framework for Evaluating the Urban Built Environment

Towards Wellness in Design: A Framework for Evaluating the Urban Built Environment

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Why Is This Important?

Challenge
How can the built environment foster positive health outcomes long before any patient steps foot into a hospital? According to the United Nations, approximately 68% of the world’s population will be living in cities or other urban centers by 2050. Urban design has the potential to be at the forefront of improving overall population and community health in the years to come. For this reason, it is vital for communities to identify, evaluate and prioritize designing for wellness in the urban built environment.

Figure above | Original graphic. Derived from Statista using data from the UN Population Division, World Economic Forum.

Aim
This study examines two main points. First, the study examines urban design strategies for wellness, such as designing for increased physical activity or better nutrition, and these strategies’ role in impacting the health and well-being of an urban population. Second, the study seeks to create an observational methodology for measuring how existing urban design in the built environment negatively or positively impacts population wellness, with the outcome being a new tool that can be leveraged for informed decision-making. In addition, this study explores insights into the variety of built environment metrics that influence human behavior towards wellness. By delving into the field of urban design and wellness, we help increase understanding into how urban design can contribute to a broader spectrum of care.

Figure above | Original graphic. Derived from Heinle Wischer Und Partner

What We Did

Approach
This study utilizes two reviews of the literature, the creation of an observational tool to test existing environments, and pilot studies of the tool to examine how communities can benefit from understanding design for wellness in their own urban built environment.

Method
An initial literature review was conducted to understand how urban design and planning influence health and wellness broadly. Thirty-two urban design metrics, divided into five categories, were identified from the literature as influencing either psychological or physiological aspects of human health. From there, a second literature review was conducted to understand the characteristics of existing observational tools for health and wellness.

Based on the findings from the second literature review, a novel tool was developed that analyzes urban design characteristics for positive wellness outcomes. The tool, called WellMap, was created using descriptors and diagrams that allow one to score a specified study area. WellMap is designed to lend insight and prioritization to what a community or project site could do to contribute to overall healthier decision making. The WellMap tool is complemented by a design guideline matrix that offers urban design strategies dependent on the resultant rating, an Excel scorecard that automatically visualizes comparative results, and a client template for project teams to create a one-pager that summarizes all information.

What We Found

Literature review #1:

Literature review #2:

Five Factors Were Identified From the Literature Review That Influence Physiological and/or Psychological Wellness in the Built Environment:

Design Factors

Designing communities with provisions for physical activity (namely, walkability) has a sizeable impact on wellness. This impact is felt both through formal massing that affects human physical activity and through influencing external factors, such as vehicular speed, which are linked to vehicular and pedestrian fatalities.

Diversity Factors

A mix of land use and accessible destinations, such as shops within neighborhoods and communities, influences whether people choose to commute via walking, connect multiple walking trips or participate in leisurely walking.

Density Factors

As density tends to encourage mixed-use facilities, sufficient densities alongside other built environment factors increase the probability of individuals walking for transport and creating local businesses that attract people and support a local community.

Distance Factors

Access to facilities such as public parks, green spaces, health care facilities, grocery stores, third places, etc., support positive healthy lifestyle choices by allowing people to be active or practice other healthy behaviors.

Destination Factors

Major anchor institutions that spur economic development by helping to create mixed-use destinations increase the probability that residents and visitors will decide to participate in physical activity.

These five factors formed the foundation of the WellMap tool, which was piloted in three distinct areas within Atlanta.

Pilot Study Analyses

Figure above | Original graphic. Wellness + the built environment as a system of systems that interact with each other in the built environment, rather than singular variables.

Deliverable
Findings and insights from the literature reviews, WellMap tool creation and pilot studies led to the development of key considerations, design goals and a design considerations matrix for urban design and wellness. These are compiled into a comprehensive report of the study and a full PDF, Excel spreadsheet and one-page template of WellMap that is available for use and distribution to project teams.

What the Findings Mean

Application
A decentralized, holistic approach to health and wellness in our communities is trending, and urban design for health affirms this through consideration of how buildings, streets, public spaces and communities foster health and wellness for all. WellMap seeks to make stakeholders aware of the larger context in which they are operating and how their project can tie into an existing network of wellness fluidly and efficiently by identifying inequities in the built environment. What we have learned is that although urban design by itself does not ensure wellness, designing for networks of wellness can positively influence healthy human behavior. Efforts toward understanding how the built environment can foster wellness should be focused on identifying applicable study areas for project sites, evaluating what components within the study area are most important and prioritizing concrete metrics to determine how best to intervene.

Future
There are several directions that future research could lead, many of which involve testing and evaluating the efficacy of the WellMap tool, as well as its connections to wellness and health care at large. Viable options for exploration include improving user observational methodology through testing for inter-rater reliability, recommending ideal study area sizes and cross referencing WellMap scores with contextual health data to determine associations between urban design and health outcomes.

As the rise in population in urbanized areas worldwide increases, so should our efforts in designing our cities and communities to support health and wellness. This is our call as designers to respond with knowledge through designs and strategies that maintain positive health long before anyone steps foot in a hospital. The built environment and the design of the everyday will become a first line of defense and a major influencer of population health at large.

Figure above | original graphic. Health care delivery models in communities.

Gabryela Passeto

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Zach Orig

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Designing for Mental and Behavioral Health Needs — Crisis Care Spaces within Emergency Departments

Designing for Mental and Behavioral Health Needs — Crisis Care Spaces within Emergency Departments

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Why Is This Important?

Challenge
It is estimated that in the United States 1 in 8 visits to the emergency department are for a mental health or substance abuse issue. The emergency department can act as the front door for many experiencing a mental or behavioral health (MBH) crisis. This initial visit has the potential to impact how that individual feels about the health care system and their own ability to get better. For this reason, it is a vital step in our nation’s mental and behavioral health treatment plan to provide adequate and human-centered care for MBH patients presenting to the emergency department in crisis.

ORIGINAL GRAPHIC. CONTENT DERIVED FROM: Substance Abuse and Mental Health Services Administration. (2018). Key Substance Use and Mental Health Indicators in the United States: Results from the 2017 National Survey on Drug Use and Health.

Aim
This study examines psychiatric crisis care spaces (e.g., crisis stabilization units, holding units) and their role in impacting the health and well-being of individuals presenting in a MBH crisis. Insights into the multitude of factors influencing the need for psychiatric crisis services and opportunities for how design can respond and support human-centered care were also explored. By delving into the field of MBH in crisis care environments, we can provide insight into how we as designers can challenge our own understanding on designing the environment for someone in crisis.

What We Did

Approach
This study utilizes a review of the literature, industry expert interviews, a think tank, and analysis of case studies to examine the role of design in psychiatric crisis care spaces on facilitating patient health.

Method
A literature review was conducted to understand the systematic problems facing mental and behavioral health care. Twelve industry experts in the design, research and planning field of health care facilities gathered to discuss trends in emergency department planning and behavioral crisis care. For insight on the current state of crisis care environments, semi-structured interviews were conducted with experts in the fields of architectural planning and design of emergency departments and MBH facilities along with care providers of psychiatric and emergency medicine. Five case studies were selected based on their demographic location, potential patient population, and facility age. These were analyzed demonstrating the variety of design options based on patient population and operational strategies.

What We Found

Review of the literature: Many design responses for crisis care environments have not gone farther than provisions for physical safety with limited guidelines or tools that support human-centered design.

Interviews with industry experts: The operational and physical environment of emergency departments can clash with psychiatric care processes.

Think Tank: Understanding the patient population is vital to designing crisis care environments and the impact on ED planning.

Case study analysis: Design responses across the case studies show a vast difference in how environments can be designed for MBH patients.

Access measures include access to insurance, treatment, special education, quality and cost of insurance, and workforce availability. Higher access ranking indicates that a state provides relatively more access to insurance and mental health treatment. GRAPHIC ADAPTED FROM: Hellebuyck, M., Halpern, M., Nguyen, T., Fritze, D. (2018). The State of Mental Health in America 2019. Alexandria, VA. Mental Health America.

Four factors were identified as influences in MBH crisis care:

Social Factors
Socioeconomic factors influenced by federal and state lawmakers disproportionately impact Americans. This has been shown through census data on emergency department visits and access to care. Social stigmas have a substantial impact on public health and may negatively impact opportunities for good jobs, housing, and health care.

Operational Factors
The variations in appropriate staff training for psychiatric care within emergency departments is a prevalent issue. Literature pointed to more emergency medicine staff being cross trained to care for those presenting with a MBH condition. Security protocols for MBH patients in the ED was found to often dictate the clinical protocols for this patient population.

Built Environment Factors
Literature reviewing patient experiences within emergency departments stressed the trauma reported from the ‘cold’ & ‘clinical’ environments when visiting the ED in emotional distress.

Built Environment Factors
Individual factors such as self-stigma’s and specific MBH conditions were reviewed to better understand the range of care needs. Patients with severe mental illness were found to have an increased risk for poor clinical outcomes despite the increased resources utilized or their length of stay. A substantial portion of the literature reviewed demographics of ED visits with many MBH patients presenting with physical ailments as their chief complaint, supporting the knowledge that co-morbidities are prevalent in this patient population

Deliverable
Findings and insights from the literature review, interviews, think tank, and case study analysis led to the development of key considerations, design goals, and a design considerations checklist for crisis care environments, which are compiled into a comprehensive report of the study.

What the Findings Mean

Application
For many, the emergency department may serve as one of the only choices to receive care. What we have learned from psychiatric care, is that MBH patients have specific needs that may conflict with the typical operations of emergency departments. This environment is challenged to function for both while supporting patient-centered care. By having a clear understanding of who is expected to be served, designers can better plan and design environments to support this patient population.

Future
As the rise in mental health service needs increases, so should our efforts in designing environments that support both MBH patients and care providers. This is our call as designers to respond with knowledge through design and strategies that maintain human-centered MBH care for all.

 

Hannah Shultz

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Outpatient Waiting Behaviours: A Cross-Cultural Pilot Study in the U.K. and China

Hospital Waiting Room in China

Outpatient Waiting Behaviours: A Cross-Cultural Pilot Study in the U.K. and China

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What is the Aim

Challenge
Waiting is a well-established issue in health care. Patients wait for appointments, then wait again in waiting and exam rooms. It is a common problem often caused by insufficient resources, and in some cases, by inadequate organisation or timekeeping. These issues cannot be directly solved by architectural and interior design, but design could help mitigate the impacts of long waits. A patient’s wait time impacts their perception of the quality of care they receive as well as the perceived kindness and empathy of the staff. But that’s not all. Feeling like the waiting time is excessive can have the same effect on satisfaction rates as the actual wait time. The majority of available health care design research has been conducted in North America and Northern Europe. As designers, we have little choice but to apply this contextually specific research to a wide range of health care systems as well as cultural and demographic conditions. Some research may transfer and generate intended outcomes; however, much will not. There is currently little way to know what works and what doesn’t in contexts outside of those where the original study was conducted.

Aim
The study sought to discover what, if any, differences in waiting behaviours exist between two dramatically different cultures; China and the UK. Given the lack of existing information on this topic, it was critical to conduct a study that establishes whether our suspicions were correct so that further, broader and more in-depth research can be conducted in the future.

The majority of available health care design research has been conducted in North America and Northern Europe. As designers, we have little choice but to apply this contextually specific research to a wide range of health care systems.

What We did

Method
Outpatient waiting areas of three public health care facilities — two in Shanghai and one in the UK — were the locations of the study. A mixed-methods approach was used to maximise the qualitative and quantitative data gathering:

Behaviour Mapping
Sound Level Measurements
Photographic Surveys and Shadowing/Close Observation.

All methods were implemented over two days each at one facility in Shanghai and the UK facility. At the third facility, only Sound Level Measurements were recorded over one day.

What We Found

Phone usage was higher on average in China than the UK but more uniform across generations in the UK than in China. Therefore, phone usage should be considered a key behaviour to provide for and design for in both contexts. This could include phone charging points, quiet conversation areas or call booths. This would reduce some anxiety associated with phones losing battery power, disturbing phone calls made in the main waiting areas and the fear of missing being called for an appointment while trying to find a quiet spot for a phone call.

Sites in the UK and China could improve communication and information dissemination. Anxiety heightened when visitors did not know how long they would have to wait because of the impact an extended wait might have on childcare, work commitments or even parking tickets.

Improved information accuracy and dissemination with respect to waiting times is a key recommendation for both locations as this single move could reduce a lot of associated anxieties and impatient behaviours. Consideration should be given to hearing- and vision-impaired users as both facilities are in countries with significant aging populations.

Notice board where nurses communicate Clinician delay information at Hospital C.
Digital information screens at BOE Hefei Digital Hospital in Hefei, China

Eating and drinking were far more common in the Chinese facilities than the UK facility. This occurred even though food and drink were provided in the waiting space in the UK in the form of vending machines while there was no food provision on the site of the Chinese facilities. To respond to the eating habits in the Chinese facility, we recommend that more food and drink options be provided on-site. Also, appropriate furniture —such as tables and chairs and not only bench seating —should be provided to accommodate well-established behaviour patterns.

Cafe concept at Lanhai Medical Center, the World’s Largest Clinic in the Luijiazui Financil Center in Shanghai, China

A key finding was the differences in personal space and conversation preferences between users in China and the UK. In China, visitors were often conversational with others, whether they knew them or not. In the UK, visitors preferred to be separated from others in the waiting area who were not in their party. The seating in neither setting supported the preferred interaction levels of the visitors. This is a key behavioural difference and must be considered in all cultural settings.

What the Findings Mean

This study has established a toolkit of considerations that should be reviewed by all designers working on health care projects worldwide. These considerations should each be evaluated within the specific socio-cultural context of the project to ensure we deliver environments that are highly and accurately attuned to the needs of the users. This toolkit can be used as part of our proposals for projects outside of the cultural West to highlight our unique emphasis on understanding the nuances of local user groups’ preferences and needs within the health care environment.

Deborah Wingler, PhD

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2019 HKS Health Fellow Will Research the Effect of Emergency Departments on Psychiatric Patients

2019 HKS Health Fellow Will Research the Effect of Emergency Departments on Psychiatric Patients

Clemson University graduate Hannah Shultz has joined HKS as our 2019 Health Fellow. The annual fellowship allows a health care design graduate to spend a year researching a topic while working on projects with designers at one of the most influential architectural firms in the industry.

The prestigious fellowship — open to applicants finishing their undergraduate or graduate studies — is much more than an academic opportunity to delve into a topic of choice. The winning applicant is given full-time employment at HKS and the opportunity to continue his or her career with the firm after the one-year fellowship term.

“We prioritize research in everything we do, and the fellowship infuses this mentality into a unique entry-level position,” said Southern Ellis, a designer in our health group and 2011 Health Fellow. “It’s creating the next leaders in our firm.”

Shultz, who is based in our Dallas office, will study the impact of emergency department environments on patients who show up at the door experiencing a mental health crisis. She’ll work with a committee of HKS leaders to refine the parameters of her research and to receive guidance throughout her fellowship. 

“We need better design guidelines for the initial planning in the redesign of emergency departments,” Shultz said.

Her interest in behavioral and mental health dovetails with the pursuits of HKS’ health group, including a comprehensive addiction recovery center that recently opened in Oklahoma and our partnership with the state of Texas to revamp two public psychiatric hospitals.

A native of Alton, Missouri, Shultz attended the University of Missouri-Columbia and channeled her passion for art into a bachelor’s degree in architectural studies with an emphasis in interior design. She became an undergraduate research assistant, helping a graduate team evaluate trauma room data and separately conducting research on simulation rooms for medical students. After graduation, Shultz joined a commercial interior design firm and worked in St. Louis for a year before pursuing graduate studies in health care design.

Shultz moved to South Carolina after gaining admission into Clemson University’s distinguished Architecture + Health program. She was also offered a graduate assistant position in Clemson’s Center for Health Facilities Design and Testing, a multidisciplinary group of researchers, practitioners and industry experts who seek to improve people’s health through better architecture and building design.

As graduation approached, Shultz began applying for design fellowships. She said the HKS Health Fellowship was her top pick because of the program’s longevity and the firm’s expertise in emergency department design, emphasis on research and wealth of resources.

“There’s so much passion that I felt just by being here,” said Shultz, who started at HKS in July after graduating from Clemson in the spring. “It’s very reassuring for somebody who just came out of a three-year master’s degree. It feels good to keep up that momentum of chasing a dream, of not losing the greater vision.”

At the end of the fellowship, the designer delivers results. That might be a research paper or a design tool, such as the benchmarking and data collection practice developed by 2016 fellow Kaitlyn Badlato to measure the performance of HKS health projects. Other fellows have studied how policies and population trends are shaping Chinese medical facilities and the role of empathy in health care design. 

“HKS is doing everything in our power to fill our firm with incredible people and to invest in research so we have informed decisions on everything we design,” said Ellis, whose fellowship experience propelled him to become a mentor in the program. “When you’re in a meeting with someone from HKS, you know this is a firm that invests in those two things.”

How Will Health Care Design in China Be Impacted by Social and Health Policies, and Demographic and Population Health Trends?

How Will Health Care Design in China Be Impacted by Social and Health Policies, and Demographic and Population Health Trends?

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What is the Aim

Challenge
Much has been written about China’s health care system and the strides it has made in public health, but less attention has been paid to the physical environments this progress has made within. There is a lack of coherent information regarding China’s health policies and demographic trends as they relate to the design of health care environments. Health care design is inextricably linked to the achievement of government targets in public health and should be taken as seriously as improvements in education, funding and human resources.

Aim
This report aims to provide key areas of focus for the planning and design of health care facilities in China to ensure that facilities designed and built in the coming years can cope with existing and future challenges as well as actively contribute to the achievement of government health goals.

What We Did

Approach
Data and information from publicly available government policy documents and national health statistics, reports and data from international non-government organisations, and journal articles regarding contemporary conditions in China’s health care system were compiled and analysed.

Method
Data and information were collated to form a clear story of China’s current health care market and population health as well as aims for them in the coming years in relation to the design of health care facilities in the country. Although the government publishes annual statistics, it is not always clear how the figures have been reached and the years for comparison are not always consistent. Meanwhile, some publications provided more detail regarding how the statistics were calculated than others. This meant that the author used as many documents as possible to gather trend data on various health statistics.

What We Found

Results
Four key impact areas emerged from the study:

The Urban-Rural Divide
The urban-rural divide in China’s health care is one of the biggest problems the nation’s policymakers face. It can be seen most keenly in the differences in infant mortality rates. While infant mortality is decreasing rapidly across the country, in 2017 the rate for rural areas was still almost double that of urban.

National Health and Safety Commission of the People’s Republic of China, 2017 Department for Environment, Food & Rural Affairs, 2017

By 2030 it is predicted that there will be an additional 61 cities with populations of one million or more in China. Narrowing the gap between urban and rural health is a key target of current Chinese health policy. As China’s population swells and urbanizes in the coming decades, health care environments must be ready to accommodate these changes. Planners should focus on flexibility, for example, modular systems could be implemented to enable maximum future elasticity in urban centres.

In addition, a method of elevating the quality of rural primary health facilities could be developing a standardised unit that can be replicated across the nation. Through unity, a higher level of quality control and equality of provision could be achieved. The targeted improvement of the quality of the built environment of rural primary health facilities will be a prerequisite for reducing the urban-rural divide.

Health Insurance and Current Health Policy
In 1998 China began a social medical insurance system to cover the basic medical needs of workers. This has since expanded to achieve more than 95% (basic) coverage of the total population in 2014 (Chen & Xu, 2016).

An impact of increasing levels of medical insurance coverage and strengthening primary health care to engage people to make better decisions about their health and health-seeking behaviours, will be a reduction in hospitalizations and emergency care use as well as improved outcomes and patient satisfaction (China Joint Study Partnership, 2016). With current health policy and government targets aiming to improve primary health care and address imbalances in the insurance system to encourage people to use primary care, the current strain on ED and outpatient hospital space may well be reduced. Therefore, while some health care environments (Primary & Community Health) need to increase in capacity and improve in quality of design, other areas (Emergency and Hospital Outpatients) should reduce in required capacity in line with these moves aimed at reducing the hospital-centric nature of China’s health care system. It is therefore a risk to only build larger facilities to accommodate current challenges of volume. Flexibility in programme and spatial requirements should be incorporated for when these challenges shift and subside.

The State Council Information Office of the People’s Republic of China, 2017

The One Child Policy and Demographics
The infamous family planning policy limiting how many children a couple were permitted to have was introduced in 1979 in an effort to prevent the crisis in population size that was predicted in the following century. The most noticeable impact of the Policy, and the most threatening to the health care system, is that of the increasing proportion of the elderly population. The impacts of the One Child Policy mean that China’s Old Age Dependency ratio is projected to more than triple between 2015-2050 (United Nations, 2017) putting an unprecedented burden on the children and grandchildren of the elderly.

With no mature elderly care market to ‘fix’, and a culture that prioritizes ageing at home under the care of family members, China needs to carefully consider how to best provide the medical, social and emotional care for its ageing population. China has an opportunity to create new typologies, in design, function and operation models, unique to its needs.

Extracted from data contained in the United Nations, 2017. World Population Prospects: The 2017 Revision, Volume II: Demographic Profiles

The End of the One Child Policy Relating to the Care of Women and Children
The recent changes to family planning policy in China is a significant change and impacts family dynamics, and attitudes to the treatment of pregnant women and children. In China the rate of intervention during delivery has been especially high. In 2014 Chinese reports on the national average caesarean rate ranged from 38% – 58% while the UK’s caesarean section rate was 26%. The reasons for China’s high caesarean rates are complex and include demand side drivers such as women requesting the procedure as they feel it is safer or they fear vaginal delivery, and supply side drivers such as financial incentives resulting in caesarean sections becoming an increasingly important source of revenue for hospitals (Liang, J., et al. 2018).

Hellerstein, S., Feldman, S., Duan, T., 2014

From each of these key impact areas two design recommendations or opportunities were extracted:

Deliverable
The results are presented in the form of  a written report supported by graphs, tables and other graphics to visually represent data and conclusions.

What the Findings Mean

Application
HKS is a global firm working all over the world, including in China’s health care market. It will be beneficial to designers and planners to understand problems and opportunities that exist in the health care market in 2019, and those that might develop over the next decades, to ensure that the facilities we design today continue to serve users’ needs and government objectives for years to come.

Future
This knowledge, and further knowledge built from this report, will enable designers to directly contribute to the achievements of public health targets in China. 

Acknowledgments

Team Members:
Sophie Crocker

Funding:
Health Fellowship

Kick-Starting Your Career — The HKS Health Fellowship

Kick-Starting Your Career — The HKS Health Fellowship

The transition from academia to the workforce — with its deadlines, budgets and client demands — can be a crash course for young professionals. The HKS Health Fellowship helps recent health care design graduates bridge the two worlds with a unique experience in the health care field. Participants — a single applicant is chosen annually for the one-year program — reserve a portion of their Fellowship for research on a proposal they submit, while enjoying many other benefits.

“Architecture is unique in that it changes with the world around it. The Fellowship allows you to feel that,” said Tyler Schwede, 2014 Health Fellow. “[The Fellowship] got me into three conferences in my first year after graduation, and it put me in front of CEOs, allowed me to travel and it catered to what I thought was important. Research opened these previously inaccessible doors.”

These aspiring health leaders work under the guidance of some of the most influential architects and researchers in the profession and they are exposed to opportunities for networking, travel and more. In addition, the Fellow joins a tight-knit community of designers who encourage each other to make a difference in the field.

“This Fellowship is our own little fraternity,” Tyler says. “We hold a lot of the firm’s research and we know the people who make the big impacts. You’re at an advantage because you know all the people that are a part of this and it’s always improving.”

2014 Healthcare Fellows

Sophie Crocker applied because she was working in China’s architecture industry and was frustrated with a lack of local research in health care. Through the Fellowship, she spent several months in China in 2018 and produced several reports she plans to submit at conferences. When she submitted her research idea, Fellowship leaders helped her refine her proposal without redefining it.

“My proposal was pretty big,” Sophie says. “Although I got a lot of support in framing my study to be more manageable, it was still very much focused on making sure I was doing what I wanted to do and not trying to push me into some pre-designed objective.”

Most Fellows, such as Tyler, begin the Fellowship immediately after college but Sophie spent two years working in the field before joining the Fellowship. Both undergrad and graduate students in their final semesters are eligible to apply.

Former Fellows say the program helps them get a jump-start toward a successful career. “In school, you’re used to doing all this research and pursuing topics you’re intimately interested in, but when you get into the field you’re put on a team and you’re assigned a project,” said Southern Ellis, 2011’s Fellow. “The Health Fellowship helps you bridge that gap with research and discovering what you’re passionate about.”

Past proposals have addressed a variety of topics. Kaitlyn Badlato, the 2016 Fellow, developed a method of benchmarking for HKS’ health projects, a process vital to improving design and understanding a building’s impact. And Tyler researched how to make inpatient units more efficient by basing design on walking frequency instead of distance while Lindsay Todd, the 2010 Fellow, shadowed an inpatient oncology nurse for six months to better understand how our designs impact the user experience.

“It’s forever changed the way I approach design as a health care architect,” Lindsay says. The Fellowship “affords recent graduates that push to challenge, imagine and to ask what if.”

The Fellowship’s schedule accommodates the research proposal and applicant. Some Fellows dedicate several months in a row to research, but others reserve a portion of each week and some work in spurts throughout the year.

The Fellowship was organized to recognize and encourage recent graduates with a passion for health care design, but Southern, a health care designer with HKS and an administrator of the Fellowship, says that it has grown into something more. After their Fellowship year, participants are challenged to become leaders within the HKS health group and the design industry.

“We’ve seen that fanning the flame of these future leaders and giving them the tools and exposure to be successful has created an avenue for our health studio to have an increasing impact around the world,” Southern says.

And Kaitlyn says the Fellowship carries personal value for its participants as well.

“It’s been great to know that my work has had an impact and it’s relevant to what people are working on today,” Kaitlyn says. “People who bring something different to the table are always welcome.”

Can you design a healthier future? Learn more about the HKS Health Fellowship.

Lindsay Stevenson

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Measuring Up: Benchmarking Health Care Architecture

Measuring Up: Benchmarking Health Care Architecture

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Today’s hospitals struggle to find a balance between providing the highest quality of care, achieving high levels of patient and staff satisfaction, and realizing operational efficiency. Evolving patient care models and advances in medicine directly impact building standards, often resulting in increased facility size.

Benchmarking, the systematic process of measuring one’s performance against recognized leaders for determining best practices, is a continuous exercise that can be applied to determine the appropriate size for health care facilities. (National Research Council, 2005) In its simplest form, benchmarking assists organizations to identify areas of achievement and improvement to define a better, more successful outcome. (McCabe, 2001)

It is important to understand that there is no “one size fits all” solution; it is necessary to go beyond the numbers and understand what conditions and variables were responsible for generating them. Seeking these conditions and analyzing multiple metrics will help deliver the necessary insights to discover both planning performance gaps and best practices.

In the architecture industry, benchmarking is an often-overlooked practice. It is difficult to determine the appropriate metrics to measure and to find accurate, “apples-to-apples” comparisons for projects. Benchmarking is typically approached as a singular, project-based initiative. In these casual benchmarking exercises, it is difficult to determine the appropriate metrics to measure and to find accurate comparisons for projects.

It is important to understand that there is no “one size fits all” solution; it is necessary to go beyond the numbers and understand what conditions and variables were responsible for generating them.

Benchmarking should be a source of continuous improvement — not a one-time effort. Implementation of a benchmarking practice eliminates the need for repetitive work, while providing opportunities for in-depth performance analysis.

Architecture is a decision-making process. While each decision that is made has an outcome, collectively it is difficult to measure the impact of each of these individual outcomes. The decisions made in the health care design process can translate directly to a health care facility’s functional performance and outcomes. Benchmarking isolates design decisions through the use of metrics, quantifying the value of the individual strategies implement and comparing the outcome to others in the industry. Benchmarking can transform the design process into a tool to measure performance, determine baselines, establish targeted outcomes, provide accurate comparisons to industry leaders and deliver uniform data firm (and industry) wide.

I conducted this study as part of the 2016 HKS Health Fellowship, a six-month program for recent graduates to conduct a research project in the field of health care. The following is an overview of my work.

What Was the Aim?

This project was initiated in response to the need for a stronger presence of benchmarking within HKS Health and to evaluate the use of an industry benchmarking program, the Construction Industry Institute (CII) Health Care Benchmarking Program. In conducting this research, I sought to:

What I Did

Literature Review
I conducted an initial literature review to assess the standard processes for benchmarking and evaluate applicable benchmarking programs within the design industry, including programs at the General Services Administration (GSA), the Department of Energy and tools developed by industry organizations such as the Advisory Board Company and the International Facility Management Association (IFMA). The benchmarking roadmap developed by Robert Camp, the creator of benchmarking, was used as a guide for establishing the processes required to launch a continuous benchmarking practice. This roadmap provides guidance for developing and maintaining a benchmarking practice to determine the needs of the users, ideal processes and current deficiencies and methods for integration into an organization.

Conversations with HKS Health Stakeholders
The current conditions of data collection and benchmarking within HKS Health were identified through conversations and webinars with key stakeholders. I interviewed 15 stakeholders selected for their expertise architecture, medical planning, strategy and business development, with representation from HKS Knox Advisors, HKS Practice Technology and HKS Knowledge Management. We discussed current data collection and analysis procedures, areas that could benefit from a benchmarking practice and the infrastructure required and available for a database.

Health Group Benchmarking Survey
Following these conversations, additional information was needed from the larger body of the health group. I conducted a Health Group Benchmarking Survey, tapping 250 architects, medical planners and members of HKS Knox Advisors to understand the current health care benchmarking and data collection habits, concerns and considerations. 53 survey responses from 11 US offices provided an honest evaluation and revealed both deficiencies and opportunities within existing practice.

Participation in the Construction Industry Institute (CII) Health Care Benchmarking Program
To explore the benefits of benchmarking in an external industry program, participation in the Construction Industry Institute (CII) Health Care Benchmarking Program was initiated. HKS’ participation included entering one of our recently completed projects, an inpatient hospital tower addition, into the CII database. This allowed HKS to utilize the CII Performance Assessment System to benchmark the performance of the project against design firms across the industry, in the categories of cost, schedule, dimension and planning.

What We Found

A benchmarking practice will grant users the power to:

To transform current data collection practices into an investment for future projects and benchmarking into a firm-wide benefit at HKS, we must consider the following:

An accurate view of HKS’ performance requires the firm to assess external benchmarks in order to compare our performance to others in the industry. Participation in a national benchmarking program will provide concrete metrics to indicate areas in which HKS is an industry leader, as well as insights into markets where we could improve. An industry-wide benchmarking program, external to HKS will prove effective, it meets the following criteria:

What the Findings Mean

Implementing a benchmarking practice will require two initial efforts: an initiative to collect data and the development of an infrastructure to store and manage it.

Establishing a benchmarking practice within HKS will require a cultural change. Educating members about the practice of benchmarking and the system that has been developed for HKS will require a supplementary effort to ensure that the practice is understood and utilized to its greatest potential. The practice of benchmarking must be integrated into all aspects of a project’s life cycle, including the use of metrics as a decision making tool in the planning and design phases and the collection of data throughout the duration of the project.

Our benchmarking practice will be a continuous effort and a means of continuous improvement for HKS. We will need to evaluate our benchmarking practice on an ongoing basis to determine our return on the investment, and also to evolve it as necessary to align with the needs of the health group, our clients and the industry.

What’s Next

Moving forward, additional steps are required to implement a successful benchmarking practice within HKS. The next phase of this research will provide a more in-depth approach for implementing a new benchmarking program. Additional actions required to reach successful implementation include: