- Good afternoon, ladies and gentlemen.

Welcome to the weekly Architecture for Health lecture series.

My name is George Mann and we have an exciting program today.

And I'm gonna turn this right over to Dr. Xuemei Zhu to introduce our speakers.

So Xuemei, please take it away and thank you.

- Thank you, George, and welcome everyone.

So it's really great, my great pleasure to be here, to introduce today to our guest speakers, Mr. Mattia Flabiano, and also Mr. Robert Doane from Page.

They have been wonderful supporters for our health program and also our HIAC, which is Health Industry Advisory Council.

So I will give you a brief introduction before we listen to their lecture.

So Mr. Mattia Flabiano, has been with Page for 40 years and he had a lot of experience with really complex and mission critical type projects.

So that includes academic research institution, micro electronic fabrication facility, as well as pretty much all possible type of facility you could imagine in architecture industry.

He has a lot of experience and his wonderful management style has provided leadership to Page.

(indistinct) 19 for manual forms, really compact and successful project.

So he will be sharing his experience and especially in terms of how to understand the really dynamic nature of design in a rapidly changing world.

We know is constantly changing in every minute and a second.

And how a multi-disciplinary group of designers could really work best in a collaborative manner.

Mattia has also taken on many in leadership roles with AIA, and he has been serving on committees like AIA Political Action Committee, AIA Large Firm Round Table, AIA Advocacy, as well as AIA American College of Healthcare Architects.

So Mattia, I don't know how you're doing nowadays altogether.

(Xuemei chuckles) But hopefully we'll hear some of your tips today.

And also we have our speaker, Mr. Robert Doane.

He's a principal at Page, and the house sector leader in his Dallas office.

He collaborates with the Page team on really diverse healthcare projects throughout the world.

And also it's important to mention he's a Aggie.

So it's wonderful to have you back on the Aggie land.

It's always very special for us to have Aggies coming back.

He is a member of the Academy of Architecture for Health, with the AIA, and also a member of the American College of Healthcare Architects.

He's been spending 35 years dedicated to creating better health environments for patients, family, and the staff.

So again, a warm welcome, and it's my pleasure to introduce both of you to the lecture series.

So it's all yours Mattia and then Robert, yeah.

- All right, so I'll kick it off and again, thank you for the introduction.

It was awesome.

I'm actually an Aggie as well.

I graduated a few years before Robert.

So, always good to come back, always good to share kind of where we've been.

And we'll talk about that.

Our complex typology and all, we all talk about the rapid changes in healthcare design, in healthcare facilities.

Certainly Robert and I have been doing this for quite a long time.

Next, Robert.

- Here with a little (indistinct).

- So I just, I wanted... A little bit about Page.

When I joined the firm we had about 80 people.

We're now actually over 700 people.

We had three offices at the time.

Now we have nine offices that we practice globally.

We are the oldest firm in the Southwest, 1898 is when we were created in Austin.

And we've consistently grown.

We've been through probably six or seven transitions over that time.

So leadership change is something that we do very well for continuity and that type of thing.

And you can tell by the length of some of our key leadership and people.

They come to Page and they stay a long time, next.

So, the reason we talk about market sectors, we actually have several more, but these market sectors as we well know, all interrelate with each other.

The work we do for corporate commercial in wellness, in terms of the workplace environment, academic medical centers, the research components that go with that, housing hospitality, and our science and tech, they all come together to really drive where healthcare has been going, and where it will be going in the future.

Just a breadth of the services that we provide in the firm.

And the reason we're showing this is these touch on everything we do.

And, you know, we've got engineering in-house.

We use outside consultants, but what it does is it creates a dynamic within our office and within our architects and planners, that they understand the complete systems that go into any building, especially healthcare that are 24/7, 365.

I mean, they are definitely mission critical type facilities.

We talk about why a concept car, and that's kind of healthcare and developing scenarios and trying to create a vision for what's in the future.

And if you, if you think about a concept car it's sketched, it's drawn, it may not come to production for five years, but the ideas around that drive the industry.

And so when we look at design of healthcare facilities, we are always looking ahead.

Defining innovation, it's really the nexus between viability, desirability and feasibility.

And without those three components, you don't have innovation and that's where it's created.

Next, Robert.

- So just a little bit about predictions of the future.

We just kind of love the Jetson slides.

So maybe some of our audience here will have caught it on the Cartoon Network at some point, but when Mattia and I were growing up, this was like our favorite cartoon to watch on Saturday morning TV.

But it's really interesting to note that, you know, something that was developed in the late fifties and the early sixties forecasts telemedicine and flat-screen TVs, and the wonderful PillCam that we can swallow a pill, and we can actually take a picture of the inside of our bodies or even a smartwatch.

So where is that technology headed as we move forward?

What are the future's predictions that we are looking at today, and how are they gonna affect our industry?

There's a lot on robotics.

3D printing is a real amazing component.

It's really helping our industry and healthcare amazingly.

But it's not just that, AI is out there, robotics are out there, nano-medicines are out there.

And really, all of these pieces are really just changing the healthcare of tomorrow.

This was an interesting study that UCSF did in their college of nursing for right before the pandemic in December of 2019, where they kinda were forecasting what would, what would healthcare look like in 2050?

But the key to that was, you know, literally one and a half months before it came live and came real, here's the prediction of we'll have a global pandemic and it's gonna really affect the world.

So, people are looking at this.

They do understand where these pieces are gonna be.

And then we can also look at utopian views of where healthcare is gonna be.

Everybody's body, can you really get a scan from these pieces and really look at all these things.

But Mattia is also gonna talk about a few things that we see as disruptors that are kind of changing our market space as well.

- So, one kind of a story, it's not related to healthcare, but it certainly has impacted us.

And I was in the Austin Airport several months ago, and ran into Michael Hinojosa who is the superintendent of the Dallas schools, and they just passed the $3.8 billion bond package to really upgrade the schools.

They've changed kind of the whole thinking about public schools, certainly in the state of Texas, but certainly at north Texas.

And he was talking about, how they do five-year plans, they do ten-year plans, and he goes, but think about what has happened in the last year.

We had a tornado that came through Dallas, a natural disaster which basically took out four of the schools for DISD in the northern sector of the city.

And if you're familiar with Dallas, it ripped right across the heart of north Dallas.

And then we had a pandemic, and the pandemic came.

That was not in their scenario.

The natural disaster was not in their scenario for five-year planning or ten-year planning.

And they had to pivot overnight.

And they had to pivot to remote learning.

They have to pivot to technology really to help them keep students on track.

And if you think about healthcare, these things disrupted caregiving across.

I mean, telemedicine was not fully engaged by physicians and all, they had to pivot directly to that.

So, some of this disruptors have helped us, and quite a few have hurt us, but all along it's like, how do you plan and for a five-year window, ten-year window, or even on a master plan?

And maybe we need to be looking at more three-year windows.

- (indistinct) part of that then just taking that and going from what is the future to what's our current reality, and how do we recognize any trends associated with that?

And obviously Mattia just spoke briefly to COVID and what that's done for everybody's world in the last two years within the healthcare industry, and not only hospitals, but outpatient facilities as well, and really life in general.

How do we look at what this has done, you know, besides wearing a mask or staying six feet apart, but how are we looking at that within how we treat our hospital and health facilities?

You know, what does a triage space need to be?

Is the emergency room okay to be accessed directly from the outside and have an intake that goes through into the hospital, or do we need to be triaging in different ways?

How does it affect staff?

I mean, we see all these things.

As we look at facilities it was the first thing that came out.

Well, we need that negative air, we've got to change the way that air is distributed in the hospital system.

But more recently we're looking at supply chain issues now.

Well, we didn't even think about that.

How is that affecting everything that we're dealing with 700 ships parked off the coast of California, and we can't get goods and supplies into the United States to support the economy, let alone the health systems themselves.

So there's a lot of things that we really need to be looking at that are variables, that are changing the way we look at healthcare.

In addition to that, we've got several organizations out there that really govern how we look at things and help to understand our processes.

The American Hospital Association, being one of them.

How they look at trends to watch, and we're always monitoring each and every one of these for, you know, retention and recruitment, for the workplace regulatory changes, growth of outpatient, health system complexity.

Each of these are all changing how we look at health systems and healthcare as a whole.

In addition to that, the Advisory Board Company.

Well, Page has been a member of this for gosh, 15 years at this point.

But of the 3000 plus health systems that are in America, there are almost 85% of those systems are actually members of the Health Care Advisory Board.

So being a part of a think tank in Washington, DC, that's really reaching out nationally, if not globally, to understand what are the pressure points, what are the things that each, each individual system is seeing?

Are there trends that we're seeing from that?

Are there unique pieces that we're seeing, whether it's on the east coast or the west coast, whether it's rural or urban?

Each of these come into how we look at and examine our health facilities as a whole?

Obviously one of the biggest trends that we've really seen out of this is, you know, the migration to outpatient.

As technology has gotten to where it's at, only the sickest of sick end up in the hospital.

So, that also creates a trend for inside of the hospital or healthcare area, that the ICU is gonna become so much more prominent than just a regular general med surge bed or general bed as a whole.

So how do we look at that, and what's important if we know we're going to outpatient?

So, consumer experience is really, really at the point of this.

The other thing that Mattia alluded to with respect to his story, with respect to the school district, but it's occurring everywhere, and that is the retailization of what we see in healthcare as a whole.

So, how do we, how do we make sure that, that we can capture the patrons and the patients that we need within our hospitals and healthcare environments?

But I want to take a step back for just a second and say that, you know, as a part of design, what can we do to really help facilitate that?

The biggest number one thing that we've seen, and this is a ten-year trend.

It's gonna continue to go flexibility, flexibility, flexibility.

How do we build things that we can change today, change tomorrow what we're doing today, and still have it work in a very efficient or effective manner?

How can we reduce cost?

And costing is in a number of ways.

Sometimes when we look at health facilities or buildings as a whole, we think about first cost, and what is it gonna cost us to build this project?

But really life cycle costing is equally as important.

How we're using energy.

How we're using daylight.

How we're getting these pieces into the building.

And how do we reduce waste?

(indistinct) runs our actual healthcare practice as a whole, and he's a Lean Six Sigma black belts.

And he often talks to our entire healthcare group.

In fact, our entire company, with respect to the ideas that are going through, with respect to how we can be more efficient with putting buildings together as a whole, the constructability aspect, the design aspect.

These are all important things to be thinking about.

So we talked about the flexibility, one of the things that we've looked at, and I think you guys may have seen this slide probably last year when we were talking about it on the clinic side is flexibility.

When we look at, how to create a general exam practice that that is both repeatable and easily buildable.

So we can go in and potentially have a clinic one day, it is a completely different clinic the next day but utilize the same space.

The idea of putting it in a condominiumized position in place for how we operate our clinics.

- But Robert, I might add on the flexibility.

I mean, you're seeing that across multiple sectors.

I mean, when we do research lab building that is looking at how do they take kind of neuro research combined with the electrical engineers and in-device and micro-device and nano-technology, and do again all within the same lab space and then trying to convert that to a computational space.

And then if you even look at microelectronics, is chip design has evolved over time.

How do they take a plant that's, you know, a multi-billion dollar plan and convert it?

And you're seeing that now with Samsung.

You're seeing that now with Texas Instruments and Intel, as they start to introduce new technologies.

- Yeah, a really good point.

So we talk about a little bit about these ideas.

There elements that maybe help organize how we put our buildings together.

But one of the things I really wanna stress with the young designers that are out there is good design still matters.

And what defines good design, right?

It's not just how we have pleasant colors and a pallet of materials to use, but you know, how we use the analytics to really utilize our spaces.

How do we look at, you know, the efficiency of a space, the repeatability of a function within a space, so that we can get (murmurs).

Well, any clinician to actually have a repeatable engagement so that we know we're not making medical errors.

These are all important pieces that we need to be paying attention to.

The whole idea, you know, Dan Stanek looked at this many, many years ago and really, how do you look at the retailization of healthcare?

We've been talking about this for quite some time, how we build buildings that really make a difference and really celebrate your brand.

At Page we've actually done about 10 new campuses for Houston Methodist.

And we took the Methodist Medical Center and then we drew a 15 mile radius around the entirety of Houston.

We've really brought in hospitals that start out at about 180 to 200 beds and expand up to 350 beds.

And we've built this nucleus of community hospitals that really support the main campus at the quaternary care facility at the med center in Houston.

And the critical piece of that was really Sid Sanders, as the vice president, senior vice president for real estate and how he looked at the key components of branding.

So he took the Houston Methodist, as a sort of iconic pediment, and made sure that each and every one of those hospital facilities had a glass atrium that reflected exactly that at every single campus.

So that was really key to how he looked at things and how we should probably look at things as a whole.

When we look at buildings, it's not just about the building component itself.

For many, many years now, we've had lead in a sustainability piece to say, the earth is important to us, but it's beyond the earth.

And in the last five years, we've really had both WELL Building Standard, as well as Fitwell come in to look at, how can you make a building function, not as a backdrop, but as an actual activity zone for day to day actions for people?

And then what is the cost associated with that?

And the great aspect of that is if we build the building right upfront, it only costs about $150 to $500 per person that's using or occupying that building to get to add components to this.

I'm gonna talk a little bit more about this, take a deeper dive into this with a few more of these slides in the future.

- So, Robert, go back one slide.

Yeah, so, healthy building.

I mean, if you look at the start of the pandemic, no vaccine inside.

The immediate questions we were getting, not only from healthcare providers, but from corporate, you know, office users, clients, I mean the big real estate company, CVRE, Cushman and Wakefield is, what do we need to do with our offices?

This was even before people were being allowed to work remotely and work from home and work really from everywhere.

And we were looking at everything from temperature scanners at the doors, changing cubicles, workspace, everything else.

Fast forward 12 months because of technology, AI and everything else that goes into research now that we're able to develop a vaccine, an effective vaccine in record time.

And part of that is a hundred years ago when we'd had other pandemics, we didn't have the technology.

We had to test for 10 years.

We had to go through that process.

So if you to look at the rapid change of what's happened, and you can talk about it politically.

You can talk about it however you want to, but the fact is it's been effective.

And so that actually changed in a year's time from really trying to change the whole workplace environment in every sector.

We're not looking at that now.

Because of the vaccine it's allowed some normalcy come back.

But what it's done is, as said everybody proceed with caution, in terms of what is the next pandemic, what is the next thing that's gonna be a disruptor in what we do.

So the thinking has really changed 180 degrees and continues to do that as we move forward.

And so, climate change will affect everything, as well natural disasters, and we have to be ready for it.

We talked about surge capacity of hospitals at one time, and that's still gonna be on the forefront, but you have to overlay that on the research that's being done as well to head this off.

Okay, Robert.

- Good, good.

That's a good segue and it is.

We looked at how buildings, what we can do with buildings.

I mean, this is exactly what Mattia was alluding to is, how does air and water and light really affect our building components and how can we respond to that to make our buildings different?

But then how can we also develop designs, like moving the stairwell forward and putting it in a public view so that people will actually use it instead of it just being a fire steer behind some kind of a door that nobody even knows is there.

So let's take a look at some of those things as they start to create or to help to define the path that we go through.

So really when we say the access to the constellation of healthcare, we do this diagram on every facility that we do.

This is kind of our bubble diagram, if you will, for how we start processes and really look at.

So in this particular one, whether there's an ambulatory health position where we both have primary care, a freestanding emergency department, maybe some type of a robust imaging facility, but all the support components for a pharmacy and nutrition and any of the other components that are gonna actually operate with the clinics themselves.

Now with this one in particular, last year we presented the Cone Health Project with the Drawbridge Project, which was a really completely new way to look at health care as a wellness program, and kinda look at how those clinics can help to support that.

But then what's our experience?

What's each user's experiences as they come to facilities with, you know, does it start digitally?

Do we look at it from that standpoint?

Do we look at a mobile presence and how we enter into the communities?

And then ultimately, what is the destination for those?

So at the UT Dell Medical School when we developed that, we really went to a full branding approach for this.

So not only the kiosk at the front, but all the way from badging.

And if you went online at the beginning of your journey for healthcare, you know, where do you park?

What school do you need to go to?

What building do you need to go to?

How do you drive into the facility?

Can you get with your smartphone all of the way to where you need to be?

But in addition to the phone, as shown on the left side, or I should say smart device, really, as we look at that, go back to the whole simple idea of just way finding.

How do we make it easy for somebody to actually see where you're supposed to be?

Oh, I'm in clinic, A, I'm in clinic B.

And how does that really work for helping your patron understand where they're going?

All the way to, where are we headed in the future?

Can we get smart kiosks that are literally at the airport or in the community center.

And you can get all your vitals taken, your understanding, get a nurse, and Mattia talked to this idea of tele-health and tele-medicine and we get that right there.

But also looking at the community connection hubs.

We're doing this in almost every facility now.

Instead of having a front lobby or something, to the extent of having an information kiosk there, it's really more electronic and it's more data and digital, and the Apple Store really invented this.

And it really has taken this to the forefront of almost every facility that we look at today.

Maybe beyond that, really the other thing is with these community connection hubs is, how do we introduce food into our daily routine?

How do we introduce healthy food into our daily routine?

Mayo Clinic is doing this.

We did this with Cone Health.

With the wellness program we're really looking at that, but also fitness and working that into what we were looking at.

And then understanding as you go through the clinical approach to things of, can we get into the virtual world with tech and SIM labs?

And then understanding how to support the clinician.

We talked about, you know, how to look at spaces, but number of steps that it takes to travel from one location to another, how do we make that efficient?

How do we make rooms and spaces within 30 feet of a windows so that we can drive daylight into an entire facility?

All of these are important components to how we really create a special building environment.

Then how do we look at that repetitiveness of modular practice and modular designs, and really understanding what we can do as a team to create, to help benefit and create that backdrop for what each of the staff are working within, but also what the patrons and families are experiencing?

- And Robert, one of the, go back one slide.

- Sure.

- So as we were looking at the clinic component of Dell Medical School in Austin, it was designed kind of as a research medical center that would support the clinicians, support the hospital, but they, and they didn't have a dean at the time.

So they ended up hiring a dean who was all about not wet research, but computational research.

Use the thought process and research being done globally and using really AI and super computers to really farm that data and become smarter, and allow the physicians to really be at the forefront of providing care.

So he wanted to remodel how a physician touches that patient, interacts with that patient and their families.

No waiting rooms, everything's electronic.

Everything's digital kind of, making way finding simple and streamline it, and also create more allowable time for the physician to interface with the patient.

Not the typical, I think it's on average they're there less than a minute, and then you're there with a nurse, practitioner or somebody else.

So it's how to increase the time with the caregiver and the knowledge base to the patient and family.

- Yeah, also we look at other areas as well, and within the hospital and where are those technologies going with hybrid ORs and cath labs and robotic imaging.

And looking at what we can be doing with the other support spaces.

Infection prevention is obviously big.

Using the smart suite for HVAC system to not only get light where we need it within the operating rooms, but allow a grid so that we have a perfect laminar flow for air in newer technologies for UV disinfection within rooms, but also within labs and in pharmacies.

And how robotics is really entered into that equation as well.

All within the hospital facility.

And then really this is the part where we talk about, what is health care versus wellcare?

Maybe that piece needs to be championed by our health facilities, as we look forward into these pieces.

So some of the pieces that we started to talk about were really, how do we make sites destination spaces?

How do we make it a place that you go to every day and not just when you're sick?

How do you create disruptors that really allow for people to come and congregate?

The idea of playing a movie in a space.

Or as we did at Discovery Green in Houston to take a parking garage and bury it so that we could make a public park in the downtown area and really create amphitheaters for gathering.

- And Robert we're creating this with many of our campus sites now.

In fact, we're working with a confidential client.

It's oncology, radiation oncology.

He wants to really create a center of excellence and looking at almost a hundred acre development.

But that he would provide kind of one component to that.

And how do you provide housing there that's needed in the community?

How do you provide the outdoor wellness space?

How do you solve food deserts within that community and area and using hospital systems and their own facility to help facilitate that within the outdoor space.

And that could be food trucks, that could be a community garden.

But the idea is to wrap those around this sense of place, and a sense of destination that now has attracted other providers that are affiliated with oncology, but maybe not necessarily, but they see the synergy that's created at this campus, that's unlike your typical healthcare system campus.

So, it's very exciting.

We're seeing this around the country at different, at different systems in different communities.

- Yeah, and it's a great segue into that.

When we were dealing with the Cone Health Project and the idea of wellness, and we really looked at the whole food component to the point that they wanted to create their own vegetable gardens, they wanted to grow their own vegetables right there on property.

And then, then to have cooking classes and to have a teaching kitchen in there, and really talk about how nutrition is important and how we can really look at impacting day-to-day lives through these.

Mayo Clinic has jumped on this bandwagon as well, has been really instrumental in looking at that.

So, how do we, how do we look at wellcare as being much more a part of our healthcare journey as a whole?

We talked a little bit about the stair and bringing it forward, and how do make that a big piece of what we do?

A big component of WELL Building groupings.

But not only that, but how do you look at an inside out approach to a building?

So if you look at Greenhill here, for example, as a performance arts center, but we put their studio directly above as a port, a cachet almost for how you enter the facility.

And thus all of your, all your students and your visitors walking by can actually see the actions and the activities right through the windows.

So you really becomes a billboard for what you're focused on.

So that (indistinct).

- Yeah, it's like putting, you know, putting your care on display, putting your research on display and really almost creating called makerspace within the academic world and really engaging everybody that is part of that caregiving process.

And if you go to the next slide, Robert, you can start seeing how other sectors, corporate commercial sectors start informing, you know, how waiting rooms look?

What's that experience while you're there?

The dining space, are they institutional looking?

Are they home?

Are they exciting?

Are they fun?

Do you want us, do you wanna experience that space?

Same thing, introducing green and biophilia and other aspects, natural light and deep into the clinic spaces.

- So all of those really come to a crescendo for what is the hospital of the future, what would we look like?

And we'd just put two examples in here that we were gonna briefly touch upon, but I will say these were done for competition purposes and that they were done almost four years ago at this point.

So, the wow factor on them still looks like it's 10, 20 years from now, but this one was done for a project in the Middle East.

Really looking at the whole boutique aspect of how do you bring the hotel and the five-star hotel component directly into what a hospital environment would look like?

And then this one was done as a competition for project in India.

We're really looking at the hospital being integrated directly into the mixed use.

We talk about retail mixed use, but nobody really ever thinks about how healthcare could be a part of that same components.

How you could have that directly integrated and tied into that.

So, that's a little brief look at what Page is kinda doing and how we're looking at the future.

And with that I think (indistinct).

- So that's the, yeah, so that's the concept car.

And if you can see all the ideas, the fast changing pace of what we've been doing, what everybody's been doing within their firms, within the healthcare industry.

And it's very much conceptual but it becomes real.

And so that's kind of a glimpse that, you know, I kinda like to call it Robert and Mattia's excellent adventure over the last 40 years of healthcare or architecture.

And we show our gray hair and change.

But if you think about it, what it was in 1980 and where we've come.

And George you've been at the forefront of that with your students, in terms of forward thinking, future thinking.

And you've been doing it a long time.

You've seen the world change as well.

- Yes, thank you.

- So I request.

So I'd be happy to have questions or discussion.

- Okay, if maybe we can get the whole screen Mattia and Robert.

- Yeah, I'll unshare.

- So, why don't we open it up for discussion from the students and... - Or the studio.

(Mattia chuckles) - Or the studio, right.

- So I want to jump in.

So Mattia and Robert thanks so much.

It's really exciting to like, it's so true that what I'll think about as like far far future it could be true at one, like it could've been the next day before you realize.

So I'm particularly interested in your discussion about how healthcare is transitioning to wellcare and then better integrated into the community.

So, how do you, like (indistinct) your ideal scenario, who should it be the change leaders?

I see, understand your form is pushing for looking forward, using the more forward thinking approach.

In either your actual practice, like will there be more about how system leading to change or is it employer, or even education system taking that role in promoting next student health and wellness.

And so who have you seen as really effective change leaders and how different partners could really play together in a way that make it really efficient?

We know, on the other hand we know change is always hot, right?

You will have resistance.

So, any thought based on your experience so far.

And at last, how the design or designers individually could act more proactively in this process.

So there's a double loaded question.

(Xuemei chuckles) Yeah.

- Well, it's a complex question with a complex answer.

It's like the question with five parts and the answer with 25 parts.

So, I think the community is driving the demand for convenient healthcare.

If you look at many of the mixed use developments that are happening in around our major cities, certainly the larger cities that are very dense, where you've got multiple towers, or these multi-billion dollar investments that go in with living, you know, housing, office component retail, and you're seeing a healthcare component placed in there.

Sometimes that's driven by boutique clinics that are that within there, maybe it's part of the wellness program.

But it's providing a full service really lifestyle within that development where you may have multi thousand people that are living it within that environment, but also then more, several other thousand that are actually working there as well, and creating that destination.

So you're seeing healthcare systems, invest in that as well.

You are looking at branding that is happening.

It's a multi plicity kind of answer to that because driven by consumer demand.

And we're just seeing that continue.

- And I would probably add to that, that follow the money is always an interesting thought about absolutely everything.

So when we look at how healthcare was delivered 20 years ago, how Houston Methodist is still delivering healthcare very, very well in terms of a pay-for-play scenario.

When we look at how the future of healthcare is potentially going to be, when we're looking at, we're going to pay a certain amount per individual within your areas zone or in catchment zone for what are we looking at to deliver that health care.

Well, then the health facilities, the health systems, and quite honestly, the insurance companies, which in some cases are one and the same with the health care companies themselves, they've got to look at a new way to do this.

So, when they look at that and they go, gosh, instead of treating people once they're ill, how about we do something different to get them not to be ill?

And therefore we will all be better off and they'll have a better quality of life as well.

So, that won't happen overnight.

That is going to be something that takes decades really to reinforce.

When we look at the advent, Mattia talked a lot about the whole idea of tele-health.

And we've seen tele-health.

Probably from COVID, the most successful component of COVID for healthcare in general was tele-health, but what was the reasoning behind it?

Well, the impediment to begin with was most of your position group were kinda old like me, and didn't know if they wanted to do the computer thing.

They wanted to tangibly touch their patients and be involved with their patients.

And then they learned because they had to, they were forced to that, gosh, you know what, this really works.

But you know what was more important than that?

That CMS decided that we could actually get a payment mechanism for a full visit to a health facility via tele-health.

And that changed the world because instead of getting 10 cents on the payment, they got the full payment for it.

So, a big, big shift in where things are going.

What else is going to affect that dynamic?

Well, the physician shortage that we're gonna have, the nursing shortage that we're going to have.

So, all of those components are gonna help to shape and mold what we look at in the future.

And you're gonna have to see many, many more patients, which means you've got to do it much more conveniently.

And so electronics were being embedded in the community or being outpatient driven.

All of these are gonna be pieces that we touched on that are gonna absolutely help to change the fabric of what we're looking at for healthcare.

- Thank you for a wonderful presentation.

The information's just really intriguing.

And looking the future of health care and wellcare, I really like that concept and, you know, incorporating some of those well building standards, lead standards, and so forth in that thought process.

One of the slides that you had, mentioned that it was a one-time cost to integrate well and lead.

My question is looking at the future and how a facility may change over that time.

And I know with, well, you go through that recertification process.

How does that impact that?

I can see that one time costs might not necessarily be a one-time cost.

Can you expand on that, that thought process?

- Certainly, and I think that the way that that was structured as a soundbite, if you will.

Is more about how we can take that building components, and for, I don't know if you have a thousand patrons or employees or a hundred patrons or employees, and you look at $500, that's $50,000 or $500,000 that you're putting into that.

And it kinda goes back to the lifecycle costing versus that first costing component, does it cost more money to create a grand stair and put nice finishes on it, and bring glass into that space, than it does to just bury your stairs and force everybody to ride an elevator.

And I think that the thought process with respect to how to look at that arrangement is more about an education of a client to understand that it's really important to look at, can we do something just a little bit more or a little bit better upfront, and have a lasting impact over a period, the long period of the building, if that makes sense.

- I think there's a, you know, corporate America is also realizing that they need to be part of the solution.

So when they look at how they develop their offices, how they develop a campus, and you're seeing large campuses built, whether it's for (indistinct), for Amazon or Facebook or Google, or any of that they're tech companies.

But then you also look at financial institutions that have 6,000 people on a campus.

That's a walkable livable campus with quality food service on that campus that is nutritional.

They look at, you know, burying the elevators and creating the stairs in the open to force people to utilize the stair rather than an elevator.

It's subtle kind of wellness influences that are happening on their people, but that also, there's also benefits there on from an insurance standpoint and what they pay when you start looking at a healthy population of workers.

You're looking at lower healthcare costs as well.

So you're seeing other institutions, I mean, the Texas Instruments and people like that that have tens of thousands of employees.

If they can change the habits of their population of employees over time, it will have a significant impact, dollars-wise on the bottom line.

- I would also add that it doesn't that.

Yeah, like I'll take the nutritional eating and the teaching kitchen and that whole component.

We have huge challenges with health systems when we're looking at it.

They know the goal, and they know the noble idea that they wanna produce, but they have cost centers as well.

And they have a profit center to figure out how they make money.

And because it's not something that they've done before and they have a history with, it's a challenge for them because it becomes something that they have to invest in that they're not making money for, today.

So that is a big challenge for them in terms of how we look at the capital component of what that means as well.

So everything doesn't come perfectly within a box when we look at all these things.

And many of these ideas, we have to push and challenge.

And some of the ideas, it really helps us design professionals to really just at least nudge, right?

Lean in with these folks and nudge to say, hey, have we considered this?

Have we considered this?

Is this a good idea?

And we're not gonna get all the way to the finish line immediately for sure.

But every chance we get to take a step forward is wonderful.

- This has been a very interesting presentation.

And I wonder if it's possible for you to go to your website to show the students the overview of the diversity of staff that you have.

Are you able to do that, do you think?

(Mattia chuckles) - Well, they can go look at it.

I don't know if we wanna take this time to look at it.

I can tell you this, that we have as part of their Large Firm Roundtable, just from a firm standpoint, our board are supporting a 2030 challenge.

So the 2030 challenge is not an energy and sustainability goal.

It's really to diversify the profession of architecture by 2030.

And the initial phase is we wanna double the number of black architects that are licensed in the US.

2% of architects 50 years ago were black.

And guess what?

50 years later now, it's still 2%.

There's been very little stride within the industry to diversify.

And it's been very much, we're making strides on women in architecture, Latino x in architecture, but some of our other members of society are not represented within our institution.

So, we are part of a very active recruiting within HBCU, starting with AIA.

Looking at really the pipeline being we need to get to grade school kids, high school kids, to lead them to the design and architecture, certainly into the AEC industry.

So we're just one of the 50 to 60 large firms that have all committed it.

And I would say most, George, most of the member firms for (murmurs) are all committed to the same goal.

And so we feel like the large firms together, if we all have a common goal, we'll make that difference.

And so, you see that in the makeup of our firm, when you look at our people, when you look at who we hire, how we hire, and they've got to interact with our clients.

And so, it's changing.

It's not changing fast enough.

- Right, that was a very illuminating response.

And I appreciate what you and the other firms are doing.

That was a wonderful presentation.

And it shows the students and I what you can do with your talents of imagination.

And sometimes and very often that's how reality starts with a concept.

That was a very exciting presentation, and particularly that last slide.