Publication type: "Conference Presentations"

The Bioethics of Built Space: On the Shared Responsibilities of Bioethics and Architecture

October 16, 2020 / Dochitect / Health Design & Ethics

Presentations

Event: American Society for Bioethics + Humanities (ASBH) – Annual Meeting
Presentation type: Panel presentation & discussion
Presenters: Stowe Lock Teti, MA, HEC-C, Diana Anderson, MD, MArch, William J. Hercules, MArch, FAIA, FACHA, FACHE
Date: October 16, 2020

Session Overview

Over the past fifty or so years, our understanding of the role the environment plays in shaping us and our interactions has expanded immensely. Studies of social determinants of health have illuminated profound effects social factors and environment can have on medical outcomes and well-being. Studies of behavior have demonstrated the powerful effect environmental factors can have on decision-making. It is somewhat surprising, therefore, so little attention has been paid to the bioethics of the built environment in healthcare. We all know intuitively that the spaces we spend time in affect us, and while some intrepid healthcare architects have been exploring the power of environmental factors on behavior for decades, virtually none of this terrain has been contemplated in bioethics.

The physical environment in healthcare architecture has been associated with numerous quality and outcomes issues. As we will show, design choices can result in substantive ethical issues for not just the marginalized and vulnerable, but all of us, leading some to call for a shared decision-making in healthcare architecture that mirrors the movement in clinical medicine. In this panel discussion, we will begin by outlining a series of ethical issues in healthcare design, including the use of illusion, living laboratories, and the prevention or imposition of harm through design. We then examine the state of research practices in healthcare architecture: what has been accomplished, what hasn’t, and the challenges that lie ahead. We conclude by inviting the audience to discuss the role of bioethics in healthcare architecture.

Learning Objectives – At the end of this session, attendees will be able to:

Discuss the role the built environment plays in wellbeing and medical outcomes and provide several examples.
Be familiar with some of the most pressing ethical issues arising out of design decisions in healthcare architecture and be able to describe both evidence-based considerations and theoretical concerns.
Articulate the state of research in healthcare architecture, discuss the challenges of implementing modern research practices in ongoing and future work, and the benefits of solving the issues involved.

Conference Presentations

Physician Engagement and Perspective in the Lean Facility Design Process

September 16, 2020 / Dochitect / Design for Clinical Staff, Design for Resiliency

Presentations

Event: 6^th European Healthcare Design 2020 Congress, Awards & Exhibition
Presentation type: Poster presentation, Lean Design
Presenters: Ben Bassin, MD, Cemal Sozener, MD, MEng, Diana Anderson, MD, M.Arch, Juliet Rogers, PhD, MPH
Date: September 16, 2020

Clinician involvement is essential to the success of any healthcare design project centered around patient care delivery. Practicing physicians can contribute valuable clinical knowledge to healthcare design projects to ensure the final product meets desired patient care goals.

There are many challenges in obtaining optimal physician engagement in longitudinal design projects, including time constraints, differing priorities, competing interests, insufficient knowledge of design and development process and understanding the value of their contribution.

Because many challenges exist to optimizing physician participation in the process, balancing the perspectives of both the practicing clinician and the healthcare administrator and healthcare consultants are paramount in creating successful healing environments.

Conference Presentations

“There’s No Ramp Here” How do we cross disciplines?

March 30, 2019 / Dochitect / Evidence-Based Design, The Physician-Architect Model

Presentations

Event: Health Equity and Leadership (HEAL) conference, T.H.Chan School of Public Health, Harvard University
Title: “There’s No Ramp Here” How do we cross disciplines?
Date: March 30, 2019

Dochitect was invited to participate and run a workshop for the annual HEAL event at the Harvard T.H.Chan School of Public Health!

CLICK HERE for more information about the event!

Conference Presentations

IHCD: Architectural Form + Clinical Function: A Design Paradigm Follows

October 9, 2018 / Dochitect / Evidence-Based Design, The Physician-Architect Model

Presentations

Event: Institute for Human Centered Design, Boston
Title: Architectural Form + Clinical Function: A Design Paradigm Follows
Date: October 9, 2018

Dochitect is invited to speak at the Institute for Human Centered Design (IHCD) in Boston as part of their HUBweek 2018 open door event!

“A thought-provoking talk. I also loved your sketches.”

“Diana was amazing! So articulate and thoughtful, we are excited to see what you do next!”

“‘Design matters & design can prevent disease’ – Dr. Diana Anderson @dochitect – on #ethics in architecture & design for healthcare – speaking at @IHCDesign for #HUBweek #architecture #designmatters”

Lecture overview: The delivery and design of healthcare today is rapidly changing, and increasingly complex. How are we closing the gap between designer intent and user experience? Increasingly, clinicians are asking not only for the architect’s perspective, but to develop a skill-set and knowledge-base that will allow them to help shape the future of health. Architects aim to engage clinical professionals within research, education and practice. We all have a shared goal in seeking to enhance health outcomes through innovations in the design of healthcare spaces, technologies, care delivery systems and policies. Specialized experts who can offer unique perspectives and hybrid models in problem-solving of complex systems are increasingly seen. Through combined thinking, research-based design has expanded to understand and improve the experience within healthcare spaces.

For some patients, design can succeed where drugs may fail. For clinicians, the built environment can support and improve efficient care delivery. Current trends, ideas and next steps for design to enrich our healthcare interface are presented, including an overview of:

(1) the infrequent historical intersection and recent convergence of medicine and design;
(2) the impact of architecture on health for preventative care;
(3) the future of health with an emphasis on multidisciplinary collaborative space, technology, and health spaces within our homes.

Conference Presentations, Lectures

HUBWEEK 2018 Change Maker: How Architecture Impacts our Health

October 8, 2018 / Dochitect / Evidence-Based Design, The Physician-Architect Model

Presentations

Event: HUBweek 2018 Change Maker Conference, Boston
Title: How Architecture Impacts our Health
Date: October 8, 2018

Dochitect speaks at HUBweek 2018 in Boston as part of the Change Maker Conference event!

How Architecture Impacts our Health: Design Thinking for Medicine

The delivery and design of healthcare today is rapidly changing, and increasingly complex. How are we closing the gap between design intent and user experience? Through combined thinking, research-based design has expanded to understand and improve the experience within healthcare spaces. For some patients, design can succeed where drugs may fail. For clinicians, the built environment can support and improve efficient care delivery. Healthcare innovation can occur where architecture and medicine meet.

Conference Presentations

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

September 20, 2018 / Dochitect / Design for Clinical Staff, Evidence-Based Design, The Physician-Architect Model

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

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

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

Virtual Windows and Beyond: Design solutions to improve the mental health of clinical staff

May 27, 2017 / Dochitect / Design for Clinical Staff

Presentations

Presentation Title: Virtual Windows and Beyond: Design solutions to improve the mental health of clinical staff
Event: 6th Annual Mental Health Symposium, Virtual Ability Island Second Life
Presentation Date: Saturday, May 27, 2017
Event Location: Online in Second Life

Virtual Ability enables people with a wide range of disabilities by providing a supporting environment for them to enter and thrive in online virtual worlds. In addition to hosting the annual Mental Health Symposium, a free professional conference open to the general public, the Virtual Ability community posts exhibits and displays related to mental health on its Healthinfo Island. The theme this year was “I can relate to that.”

Dr. Anderson speaks at The Sojourner Auditorium on Virtual Ability Island in Second Life about ways in which design and virtual technologies might support the mental health and well-being of clinical staff.

Dr. Anderson was also an invited guest on The Drax Files Radio Show to discuss the topic of ‘Mental Health in a Virtual World’. Click here to listen to the podcast.

Conference Presentations, Podcasts

Disruptive Innovation: Is it time to re-think our healthcare design strategies?

November 14, 2016 / Dochitect / Design for Clinical Staff, Design for Geriatrics

Presentations

Presentation Title: Disruptive Innovation: Is it time to re-think our healthcare design strategies?
Event: Healthcare Design Expo & Conference 2016
Presentation Date: November 14, 2016
Event Location: Houston, Texas

Dr. Anderson co-leads a round table session with Dr. George Taffet, MD, FACP, Chief, Geriatrics, Baylor College of Medicine, Houston Methodist Hospital, to discuss the impact of space design on geriatric patients and clinical staff.

Session Description:

Healthcare design’s recent revolution towards improved patient experience and care delivery has remained similar for several decades. Hospital activist Dr. Leland Kaiser stated that “The hospital is a human invention and as such can be reinvented any time.” Given that there is no therapeutic value to strict bed rest, which can in fact be detrimental and lead to deconditioning- most notably in the elderly population, should the patient bed continue to be the focal point around which we design the room? Hospital corridors are already dynamic spaces of patient physical therapy, multidisciplinary team rounding, family discussions and infection control practices. Can a hospital corridor become more than a long narrow space with equipment spilling over and laundry bins scattered throughout? The notion of separating patient and staff circulation has become best practice in healthcare design over recent years. With healthcare moving in the direction of the patient becoming the advocate of their own healthcare and clinicians providing the expertise to aid patients in their decision-making, should the physical design separate what the clinical model is trying to unify? It may be time to disrupt our current design thinking and reinvent some best practice design trends.

Learning Objectives:

To challenge current healthcare design thinking through the integration of medical knowledge and upcoming clinical trends.
Outline new ways of thinking about the space needs of clinicians by considering staff utilization of space given changing medical practices, including areas for information transfer and multidisciplinary rounding practices.
Understand the geriatric patient needs and how to accommodate complex chronic illness models within the built environment.
Review circulation and flow patterns of clinicians, patients and visitors in order to discuss the on-stage/off-stage model of wayfinding within an acute care space versus the ambulatory care model.

Session Panels:

Conference Presentations

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