The Environments for Aging conference and expo is an annual destination for professionals in the senior living space. It’s a gathering of administrators, designers, builders, front-line workers, developers, and researchers to discuss the latest strategies and ideas for creating functional and attractive living environments that meet the needs of an aging world.

Environments for Aging

Links

• Hadrian’s Blog Post
• Nanuk Technologies

To create his Originals profile Benjie was interviewed on his time at Dalhousie University. The interview was recorded and added to the university’s archive and special collections so that future students can be inspired by the actions of the 52 originals.
Benjie continues to be connected to Dalhousie through his role as adjunct professor. Working closely with students allows him to learn through his teaching and he is constantly excited to help students discover solutions so that they can reach their potential.

Featured alongside Benjie is (Former Prime Minister) R.B. Bennett, (Community Leader and women’s suffragist) Eliza Ritchie, (Former Architecture Dean) Essy Baniassad, (Astronaut) Kathryn Sullivan, and (Former Deputy Prime Minister and Cabinet member) Anne McLellan

Benjie’s 52 Originals profile can be found here

How did you get started in the Syllabus Program?
I love teaching, so when Tom asked if I would join on to help out I was pretty excited. First I attended as a guest during a few sessions in the winter. Then I joined on as an instructor in spring/summer.

What is the Syllabus Program?
For technical components of the program, students complete long-distance learning modules with Athabasca University. Design is taught in each region through studios like ours following a guideline for assignments. The graded work is submitted to the RAIC for final evaluation.

The following is copied from the RAIC website:
To practice as an Architect in Canada, a person must be a registered member of an Association of Architects in one of the Provinces. Applicants for Provincial Registration must first obtain certification of their academic qualifications from the Canadian Architectural Certification Board (CACB). The Royal Architectural Institute of Canada (RAIC) Syllabus curriculum has been prepared to comply with Academic Certification Criteria adopted by the CACB as its standard for granting certification.

The RAIC offers an accessible alternative through a direct, self-paced program of academic studies, design studios, and practical experience leading to the RAIC Diploma in Architecture – accepted in Canada as equivalent to a Professional University Degree in Architecture. Graduates from the Syllabus are entitled to use the designation “Dipl. Arch.” indicating that they have completed all requirements of the RAIC Syllabus Diploma.

What do you want people to know about the Syllabus Program?
What is amazing about the program is the offering of an alternative to the university path. It takes much longer than a conventional university degree (for most students, at least a decade), but it’s hard not to be excited about providing an alternative to the conventional way of doing things. Many people incur disruption in their lives that prevent the kind of 100% focus and dedication to a university architectural degree. If you can’t make yourself committed 24/7 to a university architectural degree program for 4 years (after already completing undergraduate studies), then you have no hope of making it through. But with Syllabus, it is self-paced. The deliverables are stretched out over a long period of time. So folks who have disruption their lives, still have a chance of becoming an architect.

What do you get out of teaching in the Syllabus Program?
It’s all volunteer and every activity of the design studio from coordination to grading to planning assignments and critiquing the work falls on the volunteer teachers. But it is very rewarding. I love teaching and am privileged to teach as an adjunct at the Dalhousie University Faculty of Architecture in Halifax. Syllabus adds another dimension to learning. I really enjoy working with Tom. Apart from being a very knowledgeable instructor who counts in his CV the title of Dean at the faculty of architecture, he is a constant affirmation of the profound values of humanity in architecture. He executes these values in every engagement with the students. It reminds me that architectural education does not have to be in a static box. It is fluid, dynamic, and more than just the content or the product. That is very exciting and something I get to export both to teaching at the university and in our practice at Nycum & Associates.

More importantly, the students are very inspiring. They are managing their lives and careers, yet still do the work of the program with rigour. The biggest challenge is to not give them any slack for this. We have to demand excellence in their work. The heat is on every week. Yet they still come passionate and prepared to present. It’s hard not to come away from that without a weekly feeling of inspiration and goodness. We meet on Thursdays so Wednesday nights feel like Christmas Eve.

What advice do you have for someone who might be considering the Syllabus Program?
Get started now!

Healthcare challenges in the future do not have a roadmap of experiences on which to create policies and plans, but they will be real, massive and swift: Technology-driven change is coming to healthcare that will combine with real pressures to disrupt almost every current healthcare practice. We have seen this disruption happen to other industries (for example the music industry in the 00’s presently in education and the taxi business). Much of this change has been good for consumers, but for providers it has created a new landscape. Unlike for other industries and service providers, technology-driven change has been slow and incremental for healthcare because there is so much liability and risk. But once these factors are overcome, the current paradigm will be massively disrupted. Most of the change will not be predictable or created and managed by the people in the know. It will come through the backdoor in unexpected ways. The driver of this disruption will be the superconvergence of technologies combined with diminished financial and human resources. The current planning window for any healthcare facility must recognize that plans will be implemented during this disruption so it is very important to avoid applying current assumptions. Things to think about:
• What are the factors and technologies leading to this disruption?
• How will the roles of patients and healthcare providers change?
• What will be the role of facilities when technology enables healthcare to be delivered in environments created by algorithms and networks rather than bricks and mortar?
• What is the future of the hospital?
• How do we get ahead of this so we can seize it as an opportunity rather than be subordinated to it?

Would it be safer to have Multi Gender Change rooms in our schools and how can we design these so that BULLYING is decreased and PRIVACY is improved?

Guidelines have been released to to support transgender and gender-nonconforming students. These guidelines state “All students have a right to safe washroom and change facilities.” We are launching an open-source forum on the possible design of Multi-Gender Change rooms. To read these guidelines click here.

Based on this theme we have four variations exploring how we can improve these environments. Feel free to walk through the four variations by clicking on our 3D viewer link on the right and let us know what you think. We have also released the Sketch Up model so you can create your own version. Click on the link to the right to download the Sketch Up file and don’t hesitate to send us your model at: mail@nycum.com

In recent decades, the debate over institutionalization vs. de-institutionalization has highlighted the tensions that continue to exist between architecture and psychiatric care and treatment. This is nothing new: architecture and psychiatry have shared parallel and intertwined roles in the care and treatment of persons with mental illness for the past 200 years. For example, the influential Kirkbride asylum design formalized the theory that the built environment was a key factor in the cure of mental illness in the middle of the 19th century. Psychiatric architecture reflects moral beliefs and social systems of urbanization, community, shelter, control and our quest for utopia. It is therefore not surprising that they each address social issues with solutions that are usually prescriptive but occasionally utterly inspiring.

As the professions of psychiatry and architecture face the future, changes like virtualization, technology, convergence, integration, and availability of resources will drastically alter the social needs they serve. Present day Psychiatry will increasingly be unburdened by the need for space in which to do its work, providing an opportunity to lead all types of medical practice through the transformation of healthcare, society, and the built environment.

The article is a reference to the NXT Patient Room 2020 Prototype, a full scale prototype that involved 30 industry partners in its construction. Among these are Amuneal, Armstrong Commerical Ceiling Systems, Barrisol, Bendheim, Christian Rae Studio, Cleankeys, DuPont, Duravit, Evans and Paul, Evergreen Medical, Grohe, Hafele, Handicare, Holosonics, Infinity Drain, Intense Lighting, Jay R Smith MFG, Co., Linet Americas, Lutron, Medline, Milliken, Osram Sylvania, PK30, Duracel Powermat, Price, Savant, Skanska, Smith, Seckman, Reid, Inc., Standard Textile, Synapse, Traxon, Trufig, and Tyco.

The prototype is the kind of thing over which techies salivate. So it’s no surprise that Wired Magazine also chimed in with a piece about it entitled “What Would the Ideal Hospital Look Like in 2020?”. In their story, Wired called it “the nicest hospital you will never visit” with design touches that “make it feel like an iPhone” and references “the sterile palette of hospitals from the 1950s and 60s.” which “also brings gamification to the hospital.” The comments left by readers in response to these claims are well worth the read.

The NXT Prototype pushes the thinking on managing the spread of hospital acquired infections and endeavors to incorporate a wide range of emerging technology into patient care – all good things. It emphasizes overcoming challenges faced by patients and caregivers, such as “patient and staff safety, engagement and empowerment in care process, quality of care, and efficiencies in work processes.” These are all valid issues that need to be considered and improved in the patient room.

Unfortunately the prototype appears to be heavily influenced by its industry partners in what should be a more rigorous academic study. Instead of casting itself in the role of a patient-centered futurist, it could more appropriately call itself “what 30 highly interested members of the supply chain would do if they could bypass the architects (and patients) when hospitals are built.”

Another issue is not with the NXT Prototype itself, but the journalistic slant that sustains the simplistic concept that high-tech and high-sterility equate to better care. In the USA, hospitals compete with one another to attract patients. By extension, promote-ability is also an important factor in room design. If Hospital A can brag about offering something Hospital B does not, then hopefully Hospital A will have more patients clamoring to occupy their beds. The problem is that the important metrics of actual patient care and outcomes are replaced with the potency of trends in technology and futuristic aesthetics. This, of course, is nothing new. Seductive images of the future are keys to promoting consumer spending, but it comes at the cost of being patient-centered. Furthermore, this is an expensive room, so it also comes at the cost of patient access, especially in the USA.

When a patient room design is authentically focused on the patient experience it is known as patient-centered design. The NXT prototype promotes things that may end up contributing to an improved patient care outcome, but in themselves have failed to put the experience of a truly ill or dying patient at the center.

There has been a lot of progress in the design of the patient-centered room of the future [1, 2, 3, 4, 5, 6] and it is often reflected in both the popular media and in media created and consumed by the relatively small international circuit of Healthcare architects.

Getting the design “right” on a patient room is important because it is a room typology that is repeated many times in a single hospital project. We admit that in our patient room designs, we don’t achieve all of our objectives. Many factors – including cost, constructability, consensus building, conflicts between staff and patient ideals and others – often conspire to water down an “ideal” patient room design. It should be noted we work primarily in Canada where we are blessed to not be burdened by the corporate objectives of hospital competition. The NXT prototype will be enjoyed here as a frame of reference, but it will be understood as a fantasy. Only the aspects that offer true value will be cautiously embraced. The staff control centre and the accessible bathroom are two examples that would be of value. The size at 400 sq ft and the halo are probably no-gos.

A compounding factor in any healthcare visioning exercise is the lag between the design of the room and actual occupancy (often 3 to 5 years). To design a patient room is, by rights, to design obsolescence. In other words we can dream of integrating all kinds of technology today but in 2020, technology and medicine will be very different. In his book “The Creative Destruction of Medicine” Dr. Eric Topol demonstrates how this will be a monumental issue in the not-so-distant future because we are upon a super-convergence where today’s practice of medicine will soon be dramatically transformed to “new, individualized medicine that is enabled by digitizing humans.” The patient room has as much chance of being eliminated altogether as having a likeness to the NXT prototype.

The NXT Patient Room 2020 Prototype’s aesthetic suggests (and the Wired article infers) that healing is best done in an environment akin to being trapped inside an iPhone. But human comfort comes from what we know: the familiar. The sterile look of the 50’s hospital fused with the latest spoon feeding from Apple is probably a pretty exciting experience better suited to a futuristic theme park ride or possibly the cabin of the latest long-haul commercial airliner (sidenote: A recent project by priestmangoode offers up some exciting potential by fusing aircraft cabin design with hospital recovery spaces). The NXT room is an environment alien to anything a patient would experience in their day-to-day life. Thus, not only is the patient forced to confront the complicated and deeply unsettling realities of their own illness or procedure, they must also overcome the overwhelming sensation that nothing around them is normal. It is hard to imagine a less healing environment.

The aesthetic of the NXT Patient Room 2020 Prototype is not just designed to be futuristic, but like hospitals of the 50’s, it is inspired by sterility itself. Designing healthcare environments to minimize or prevent the spread of infection is a given and a reflection of the function of the facility. In and of itself, however, this is not patient-centered design. What a sterility aesthetic really suggests is that the patient is an infection waiting to happen. Designing a sterile environment is not difficult. Designing a patient environment that supports and promotes the individual’s physical, emotional and psychological healing, while being efficient, cost-effective and minimizing the incidence of hospital-acquired infections should be the framework for patient-centered design.

The presence of family is another sadly lacking contributor to patient comfort, care and recovery, and safety. A patient-centered room makes family welcome and comfortable. Designers must work hard to provide this in spite of the limited square footage available. The NXT Patient Room 2020 prototype, the WSJ and Wired have missed this important feature.

Being patient-centered also means enabling the efficiency of the front-line staff that care for patients. Hiding “medical” services behind indistinguishable/blank/sound & light reflective solid-surface panels means extra steps for staff who would rather be providing care than converting a room. If we are to dream – after all that’s what prototypes are about – then we need to embrace a holistic approach that conceals the intimidating gear while also improving efficiency and productivity,

With the increasing body of evidence [1, 2] pointing to the health benefits of biophilic design, the absence of natural products, daylight, views, nature, or any kind of softness in this prototype seems like a huge oversight. The only thing missing from the NXT room is an automatically triggered laser beam to kill fresh flowers brought by unwelcome visitors.

It is crucial that research continues to push current thinking about what it means for spaces to be truly patient-centered. There is plenty to learn from the NXT prototype and much of it is very good. Hopefully the next NXT prototype room (for 2030) will incorporate a human side and not just let the industrialists and techies be the ones to imagine the future. Maybe they will let patients participate, as in the example of the Saskatoon Regional Health Board in this video, where an authentic community engagement was undertaken in the design of a pediatrics hospital. Perhaps it will embrace all the good things technology has to offer while also embracing the human stuff like interaction, our place in the natural world and more elements of psychological comfort.

As it stands right now, we might choose the hospital of future 1950 over the Hospital of the Future 2020 – at least it had a pool!

Planning Solutions by Design: Reuniting Healthcare Programming and Design

Hospital planning and programming can take years, often involving a number of incremental and much politicized steps. Common pitfalls may include an underestimation of the architectural impacts the programming and planning have on the project. This often includes the building site and without architectural visualization of concepts, awareness of the inputs users are making to the program may occur too late causing delays and inappropriate compromise. For a new 200 bed expansion, Capital Health (Halifax) and the Nova Scotia department of Health and Wellness recognized the pitfalls of this traditional “program first, then plan, then design” sequence and decided to combine them into a single 7 month fast-tracked, combined and simultaneous Programming/Planning/Schematic Design process. The result was a highly iterative and interactive approach that forced to the front of the room all major internal and external conflicts that the project needed to address.

For information on the International Union of Architects’ Public Health Group (UIA/PHG), click here.

For complete UIA/PHG Forum information, click here.