The Physician-Architect Model

Clinicians for Design: A Convergence of Expertise to Enhance Cognition and Healthcare Design

Presentations

Event: The Academy of Neuroscience for Architecture (ANFA) – Congress, Salk Institute, CA
Title: Clinicians for Design: A Convergence of Expertise to Enhance Cognition and Healthcare Design How Architecture Impacts our Health
Format: Poster presentation
Authors: Eve Edelstein, Diana Anderson, Thomas Grey, Desmond O’Neill
Date: September 20-22, 2018

Dochitect participates in a Poster Presentation at The Academy of Neuroscience for Architecture 2018!

Click here to see the full 2018 ANFA Conference abstract proceedings from the “Shared Behavioral Outcomes” event

ABSTRACT:
Background:
Increasingly, clinicians are asking not only for the architect’s perspective, but to develop a design skill-set and knowledge base that will allow them to help shape the future of hospitals, medicine, and healthcare.

Purpose/Objectives:
Clinicians for Design is an international network of clinicians and researchers with a vision to inspire and accelerate the design of environments that enhance health outcomes through innovations in healthcare spaces, technologies, care delivery systems and policies (1). The inaugural Clinicians for Design workshop was hosted at the Royal College of Physicians, during the European Healthcare Design conference, London, UK in June, 2017. Thereafter, workshops and research activities with hospitals and academic medical centers are exploring key lessons learned from the clinicians, healthcare system leaders, and medical researchers. Specific objectives include the application of research to improve practice, meetings to increase clinician understanding of the architectural process, and integration of clinical expertise with design-thinking.

Methods/Results:
As ‘neuro-architectural’ research converges with clinically-informed design, it has inspired the emergence of new models of practice for dementia care. A network of like-minded clinicians, neuroscientists, and a team of geriatricians and designers have formed an alliance to enable a deeper understanding of the elements which contribute to dementia-inclusive design in healthcare facilities. A leading cause of institutionalization for those with dementia is often spatial disorientation (2). Absence of cognitive mapping in dementia can be partially compensated for by using other forms of orientation strategies (3). Therefore, the design of healthcare facilities can significantly influence one’s spatial orientation and wayfinding abilities (4). This grant funded study aims to develop a ‘Design Audit Tool’ in line with Dementia-Inclusive Design Guidelines, ensuring equality across healthcare users (5). The goal is for inclusive, accessible, and easily understood environmental design for people with dementia, based on neurological and architectural research.

Implications:
Clinicians and designers discuss their progress in identifying dementia care pathways and research outcomes using a transdisciplinary approach. The advances towards a dementia inclusive healthcare audit tool is described, including the role of experts and emerging professionals in medicine, research, and design who seek an enduring connection between clinical practice and architecture.

REFERENCES:
(1) Anderson DC, Pang SA, Edelstein EA, O’Neill D. The Convergence of Architectural Design and Health: Clinicians for Design. The Lancet. 2018. Unpublished [Submitted, under review].
(2) Monacelli AM, Cushman LA, Kavcic V, Duffy CJ. Spatial disorientation in Alzheimer‘s disease: The remembrance of things passed. Neurology. 2003 Dec 9;61(11):1491-7.
(3) Poettrich K, Weiss PH, Werner A, Lux S, Donix M, Gerber J, von Kummer R, Fink GR, Holthoff VA. Altered neural network supporting declarative long-term memory in mild cognitive impairment. Neurobiol Aging. 2009 Feb;30(2):284-98. Epub 2007 Jul 17.
(4) Marquardt G. Wayfinding for people with dementia: a review of the role of architectural design. HERD. 2011 Winter;4(2):75-90.
(5) De Suin A, O’Shea E, Timmons S, McArdle D, Gibbons P, O’Neill D, Kenneally SP, Gallagher P. Irish National Audit of Dementia Care in Acute Hospitals. Cork: National Audit of Dementia Care. 2014.

Conference Presentations

There remains a fundamental gap between the aims of hospital design and the final user experience

March 12, 2018 / Dochitect / The Physician-Architect Model

Blog Post

Publication: The BMJ Opinion, Blog Post
Publication Date: March 12, 2018
Author: Diana Anderson, MD

View Blog Post

In this latest BMJ Opinion blog post, Dochitect explores the gap between user experience in medicine and design intent in healthcare architecture.

Read the full Blog Post here.

Blog Post

Getting it Right: Designing the Process to Achieve Transformative Outcomes

November 7, 2017 / Dochitect / Evidence-Based Design, The Physician-Architect Model

Presentations

Presentation Title: Getting it Right: Designing the Process to Achieve Transformative Outcomes
Event: HealthAchive, A program by the Ontario Healthcare Association
Presentation Date: Tuesday, November 7, 2017
Event Location: Metro Toronto Convention Center, Toronto, Canada

Dochitect spoke at HealthAchieve in Toronto for the annual Capital Planning session along with Architect Tye Farrow on Process Design to Achieve Transformation Outcomes!

Read more about dochitect’s ideas on the ways clinicians and architects can find a balance between illness, health, and design in this article leading up to the talk entitled ‘Getting it right: merging medicine and architecture‘

Click here to watch this short video for a preview on what Dochitect will be discussing at the conference!

Process Design to Achieve Transformative Outcomes

Presiding:
Matthew Kenney
Director, Capital Planning and Biomedical Technology
Hamilton Health Sciences

Welcome and Opening Remarks
1:00pm

Getting it Right: Designing the Process to Achieve Transformative Outcomes
1:10pm

Despite a relationship between medicine and architecture since ancient times, the professions of hospital architecture and medical practice have rarely converged, and this convergence is recent. Since the advent of critical care technologies and advanced pharmaceutical treatments, hospital design moved into a machine-like period. Architects became challenged to maintain a sense of humanity and overcome the technical apparatus through design. Increasingly, professionals in health care and design seek shared knowledge and expertise.

An anastomosis represents the connection of two normally divergent structures; in medicine, this can mean blood vessels, or other tubular structures such as loops of intestine. This connection of separate system parts then forms a network, such as a river and its branches. How do clinicians and architects find a balance between illness, health, and design – and work together to inspire the emergence of a new mode of practice? To consider therapeutic design as a possible form of treatment requires participation of both the clinician and the architect – a true anastomosis of fields.

Dr. Diana Anderson
Physician
American Board of Internal Medicine (ABIM)
Architect
American College of Healthcare Architects (ACHA)

Tye Farrow
Senior Partner
Farrow Partnership Architects Inc.

Question and Answer Period
2:15pm

Adjournment / View Exhibits
2:30pm

Conference Presentations

The Dochitect’s Journal: A collection of writings on the intersection of Medicine and Architecture

November 1, 2017 / Dochitect / The Physician-Architect Model

Book

Book Title: The Dochitect’s Journal: A collection of writings on the intersection of Medicine and Architecture
Publisher: LAP LAMBERT Academic Publishing, 2017
Book Author: Diana Anderson, MD

Excerpt: This collection of writings on the intersection of medicine and architecture includes a variety of articles and publications from both clinical and design forums, in addition to sketches, images and photographs of health spaces and innovative ideas to support the journal notes. It is a unique look at the hybrid career model of the physician-architect and through expert commentaries addresses the future of this emerging field.

The book includes a special Introduction by D. Kirk Hamilton, PhD, FAIA, FACHA, EDAC, Professor of Health Facility Design at Texas A&M University in College Station, Texas, and past president of both the AIA Academy of Architecture for Health and the American College of Healthcare Architects.

In addition, the book also includes a special commentary chapter by Marc Sansom, MBA, Founding Director of SALUS Global Knowledge Exchange http://www.salus.global/

For colour copy requests given that the book contains a number of color images, sketches and photographs of healthcare spaces, please contact Cristina Bostan, Editor, at c.bostan@lap-publishing.com or customerservice@morebooks.de to order. Thank you.

Link to Purchase Book:

The Dochitect’s Journal Book

MedX: Architectural Design for Improved Healthcare Delivery

September 17, 2017 / Dochitect / Evidence-Based Design, The Physician-Architect Model

Presentations

Presentation Title: Architectural Design for Improved Healthcare Delivery
Event: Stanford Medicine X
Presentation Date: Sunday, September 17, 2017
Event Location: Stanford University, Palo Alto, California, USA

How might we re-envision the hospital going forward?

Designers can walk the halls and talk to clinicians, but it can be challenging to learn the intricacies of a profession and its details of practice. Hybrid professionals can provide integrated solutions which cross disciplines in new ways, thus bridging this gap. Encouraging architects to experience medicine from a perspective that is typically hidden and allowing physicians to realize how design can create a context for participation would allow for a deeper understanding of health care delivery. By applying design-thinking to medicine, multidisciplinary approaches for solving current health care challenges can be developed.

Can architectural design impact health care delivery?

A 1984 study changed the way architects design health care spaces. Post-operative patients assigned to a room with a nature view had shorter hospital stays, took fewer analgesics and received fewer negative evaluative comments. This marked the advent of Evidence-Based Design (EBD), now standard practice in health facility design. Architects moved away from design decisions based solely on tradition or opinion, and towards built environments grounded in credible research to achieve the best possible outcomes- analogous to physicians utilizing evidence in making patient care plans. EBD research has demonstrated that design interventions can impact patient outcomes by decreasing iatrogenic infections, medical errors, and length of hospitalization. The business case demonstrates ongoing operating savings when the market share impact of EBD interventions is realized.

What is the model for architects and clinicians to work together towards a common goal of evidence-based practice?

Despite this shift towards evidence-based practice, hospitalization can often result in complications unrelated to the reason for admission, followed by an irreversible decline in functional status and quality of life. Certain aspects of hospital design can contribute to this decline. Although there is no therapeutic value to bed rest, patient rooms have remained focused around the bed. How can we re-envision design to shift the focus to early mobility? Design guidelines set minimum standards for single-patient rooms given evidence for improved privacy, infection control, and quality of care. How can design find a balance between privacy and easy physical and visual accessibilities? Research has demonstrated that certain room layouts are more conducive to clinician interactions and therefore improved teamwork. Should we begin to move away from a one-size-fits-all model for patient room design?

It may be time to disrupt our current thinking and reinvent best practice design trends.

Can we leverage architectural design to solve health care challenges?

Despite the inclusion of clinicians into the design and construction process, there remains disconnect between the initial vision of those who design the hospital and final clinical use of the space.

Conference Presentations

Therapeutic Sanatorium Design: Where Hospital Architecture & Medical Practice Converge

February 25, 2017 / Dochitect / Evidence-Based Design, The Physician-Architect Model

Presentations

Organization: Texas A&M Health Science Center
Event: 2nd International History of Medicine Symposium
Location: Bryan, Texas
Date: February 25, 2017

Dochitect delivers the Keynote Address at the 2nd International Symposium on the History of Medicine and Related Disciplines, presenting the historical convergence between Medicine and Architecture.

As Keynote Speaker, Dochitect was introduced by Kirk Hamilton, Fellow & Associate Director of the Center for Health Systems & Design and Professor of Architecture at Texas A&M University.

ABSTRACT

Historical overview
The notion of our health is no longer identified primarily by the absence of illness, but instead has expanded to include a general state of well-being. In medicine, as in architecture, it seems that our ambition for total well-being has become fragmented, due in part to the subspecialisation of medical science, in addition to the rise of complex chronic illness and the need for multiple buildings types for delivering care- from our homes to traditional hospital buildings and now freestanding ambulatory centers.

The sanatorium as therapeutic architecture
The histories of hospital architecture and medical practices have rarely converged. The design of the tuberculosis sanatorium during the early 20^th century illustrates this infrequent intersection; the healthy building emphasizing contact with nature, developed to prevent the spread of contagions by isolating patients and preparing them for a return to normal life. As it preceded the era of antibiotic therapy, the sanatorium model did not necessarily offer any true effective treatment. With the advent of pharmaceutical treatments and critical care technology, hospital design moved into a more industrial period of machine-like centers designed to provide all levels of life-sustaining care. While medical science can often disguise mortality with technology, we are now revisiting the sanatorium model to de-medicalize architecture.

The future of healthy design
How do clinicians and architects find a balance between illness, health, and design? To consider therapeutic design as a possible form of treatment requires participation of both the patient and the caregiver. It may be time to shift our thinking and develop healthcare architecture focused on prevention, rehabilitation, and independent living by taking lessons from the sanatorium model. A future in which design of collective spaces can promote this convergence of care alongside cure should be our goal.

Keynote Presentations

The Dochitect – Where Medicine & Architecture Meet

June 19, 2016 / Dochitect / The Physician-Architect Model

Presentations

Podcast: The Doctor Paradox
Title: The Dochitect – Where Medicine & Architecture Meet
Date: June 19, 2016

Podcast Excerpt:

“And I realized that I didn’t think I could work in places that didn’t support how I worked”

Dr Diana Anderson is an Internal Medicine physician and trained Architect. Having the unique opportunity to view the healthcare environment though the lens’ of being both a physician and architect provides an incredible viewpoint on the world of healthcare. Dr Anderson is the founder of the website, dochitect.com, where the worlds of medicine and design collide.

Dr Anderson’s work is truly emblematic for everything this show represents in so far as it illustrates how physicians can add value in healthcare in a variety of ways.

Click here to listen to the podcast.

Podcasts

Bricks and Morals: The Ethics of Architecture for Healthcare

February 27, 2015 / Dochitect / The Physician-Architect Model

Presentations

Presentation Title: Bricks and Morals: The Ethics of Architecture for Healthcare
Event: 2015 Meltzer Fellowship in Medical Ethics, Department of Medicine, Columbia University Medical Center
Presentation Date: February 27, 2015
Event Location: New York, NY

Jay I. Meltzer Fellowship in Medical Ethics
The Meltzer Fellowship gives internal medicine residents the unique opportunity to research medical ethics issues and present their findings to their peers. The fellowship program was conceived by Dr. Jay Meltzer, clinical professor of medicine, and designed by Dr. Lerner in collaboration with Dr. Rothman. It is funded by the Vidda Foundation. Each Meltzer Fellow selects one case for an in-depth analysis of its ethical issues and analyzes the relevant literature. The work culminates in a case presentation to the medical center community.

To learn more about the Jay I. Meltzer Fellowship in Medical Ethics click here.

Overview:

As a physician-architect, I propose to address the issue of design ethics as applied to the healthcare environment. Throughout my clinical training, I have noted instances of the harmful effects of unpleasant spaces. Through this presentation, I consider the need for an alliance between design and ethics whereby the architect can assist the physician.

Beyond Traditional Clinical Ethics

Architects working on healthcare projects face ethical choices:

Do the designs for healthcare facilities include elements which enhance or harm the institution’s duty of care for the patients and families?
How do architectural designs emphasize the well-being not only of patients, but also those who care for them?
Do architects acknowledge ethical issues surrounding patient vulnerability and family stress associated with hospitalization?
To what extent should non-medical needs of family members and visitors be a factor in deciding the merits of specific designs for hospital architecture?

Designing for Basic Rights

Privacy and confidentiality are considered basic rights. Safeguarding personal health information is an ethical and legal obligation. Can privacy be created architecturally when shared patient spaces are still a reality? As we move into an era of high-tech environments, what are the ethical implications of cameras integrated into the patient room design? In the realm of institutional design, some prison buildings have been shown to violate human rights. Healthy design is a growing topic, where natural light and ventilation are considered fundamental for those incarcerated. In contrast, patient and staff spaces within hospitals are still often without access to daylight. Are building codes changing?

Therapeutic Architecture

Patient and staff satisfaction can be greatly enhanced by well-designed facilities.
Beyond patient satisfaction, the architecture can be considered in the therapeutic benefit or harm to the patient. The growing field of Evidence-Based Design demonstrates that architectural design itself serves as therapy and the environment can improve healing.
There exists a relative shortage of compassionate spaces in healthcare facilities and clinical staff is too often excluded from being provided areas for emotional expression.

Architectural design solutions are increasingly recognized as impacting the well-being of those using the spaces, both in causing harm and improving clinical outcomes.

Lectures

Drafting Meets Doctoring: An Architect’s View of Health Design as Resident Physician

September 24, 2014 / Dochitect / The Physician-Architect Model

Book Chapter

Book Title: get better! the pursuit of better health and better healthcare design at lower costs per capita. Proceedings of the 33rd UIA/PHG International Seminar. Toronto, Canada. September 24-28, 2013
Publisher: University of Florence: TESIS Inter-University Research Center, 2014
Editor: Romano Del Nord

Chapter Title: Drafting Meets Doctoring, An Architect’s View of Health Design as Resident Physician
Chapter Author: Diana C. Anderson, MD, M.Arch.
View chapter

The architect Louis Kahn said that “once challenged, the architect will find completely new shapes and means to produce the hospital, but he cannot know what the doctor knows.” Imagine the lessons learned if the architect could know what the doctor knows. Take an inside look at the hospital environment through the eyes of a dochitect, a hybrid professional in medicine and architecture.

See health design from the perspective of an architect pursuing internal medicine residency training at a large New York City teaching hospital. A design journal was kept throughout the dochitect’s medical internship to record functional annotations for each subspecialty space and their relation to form the urban hospital. Join the dochitect through core rotations including the medical intensive care unit, emergency department, cardiac care unit, outpatient clinics, infectious diseases, general medicine, and geriatrics. Case studies highlighting the importance of space design are presented. Design anecdotes and functional analysis of hospital departments emphasize the practical importance of design qualities that impact the work environment for staff and the healing environment for patients and families.

The dochitect’s practical knowledge of environmental design qualities promotes health and well-being within the hospital environment. The clinicians will find the design perspectives useful in providing insight into their daily workspace, empowering them to return to their facilities and promote changes or become involved in renovation or new construction projects; the designers will benefit from the medical perspective and the lessons learned from an architect working within various clinical environments.

Personal anecdotes from patient case studies allow for a behind-the-scenes look and a practical understanding of the use of hospital space. The architect can know what the doctor knows.

Click here to read more dochitect diary entries detailing the design lessons learned as a medical practitioner.

Links to Purchase Book:

Standard Edition Premium Edition

Additional Press:

Note This topic, “An Architect’s View of Health Design as Resident Physician,” was presented at the International Union of Architects Public Health Group (UIA/PHG) Annual Healthcare Forum in Toronto, Canada; September 26, 2013.

Book Chapter, Conference Presentations

The Hospitalization Cascade: Healing or Hazardous?

September 18, 2014 / Dochitect / Design for Clinical Staff, The Physician-Architect Model

Webinar

Event Topic: The Center for Health Design, Pecha Kucha Healthcare Facility Networking & Design Event: “Innovations in Healthcare Design”
Presentation Title: The Hospitalization Cascade: Healing or Hazardous?
Event Date: September 18, 2014

Dochitect’s Pecha Kucha discussion addresses the hazards of hospitalization.

What is Pecha Kucha? It is an informal, energetic, creative, short format presentation of 20 slides at 20 seconds per slide.

Although hospitals are places designed to diagnose, treat and heal illness, often the process of hospitalization itself causes a cascade of physiologic decline. Hospitalization is a major risk factor for older patients and is often followed by an irreversible deterioration in functional status. The negative effects begin immediately upon admission and they progress rapidly, often by the second day. A high percentage of hospitalized elderly patients end up being discharged to nursing homes, never to return to their homes or communities. What are the implications for designers who plan the healthcare campus?

Follow the process of hospitalization from the initial emergency department assessment through to discharge planning. Understand the clinical decision processes which go into making key triage decisions that determine where patients will go within the hospital. Vital medical spaces within the acute care setting are reviewed, along with ways in which hospital layout and room design can assist in preventing some of the hazards associated with the healthcare setting.

Panel Discussions

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