- Welcome to the Friday Architecture for Health lecture series.

It's great to have you with us.

It's a special treat for me today to introduce our guest speaker, really our keynote to kick off our speakers for this semester.

Our guest today is Dr. Nancy Dickey, and I had so much fun piecing together the parts of her background that I didn't already know, and we're in for a special treat.

Nancy was born on a family farm in South Dakota.

She went to high school, eventually landing in Katy, Texas, which is just South of here.

And in Katy, when she was in high school, her high school counselor said, good advice here.

You can't be a physician and have a family.

Does that sound like old advice compared to what you hear today?

But that's what she was told.

So what did she do with that?

She went to college, Stephen F. Austin, degrees in psychology and sociology.

She went to medical school.

She went to UT, the medical school in Houston, did her residency there, is board certified in family practice.

So with that platform, what happened?

1998 to 1999, Dr. Dickey served as the president of the American Medical Association.

The first woman to ever hold that office, and at that time, she was the youngest to ever hold that office.

Along the way with her work with the AMA, she developed what we now know is the patient's bill of rights.

Some of you may have encountered that or needed it, and Nancy had the leadership in making that happen.

In 1999, she came to Texas A&M as a professor in family and community medicine.

And three only, three years later, she was named president of the A&M Health Science Center, vice chancellor for health affairs.

Now what happened on her watch there?

We added three new campuses to the Health Science Center.

We added two new schools, nursing and pharmacy.

And we grew the enrollment from 880 to over 2,000, more than twice what she had started with.

You could say she'd had an impact.

Since her presidency, she has worked as the executive director of the Rural Community Health Initiative, Community Health Institute.

I always call it an initiative because she's always exploring something new and pushing the boundaries.

Doing wonderful work there for the smaller communities in our state and in our nation.

Now in the category of along the way, I touched on a couple of things with the Health Science Center, but let me add.

Along the way, 2007, elected to the National Academy of Medicine.

At the time, the National Institute of Medicine, but now known as the National Academy of Medicine.

Extraordinary prestige for a physician.

2010, she was inducted into the Texas women's hall of fame.

And oh, by the way, along the way, she delivered 4,000 babies and had three of her own.

Now, aren't you glad sometimes that we ignore the advice of high school counselors?

It is a great privilege and pleasure for me today to introduce my colleague, and fortunately for me, my very dear friend, President emeritus, Dr. Nancy Dickey.

(audience applauding) (Dr. Nancy laughing) - Thank you.

Thank you so much.

You know, you shutter a little bit when people say, I've done my homework and I have cobbled together, and I think, Ooh, what might they have found?

Unfortunately, I don't do social media, so I figured I was reasonably safe, right?

Thank you for the kind introduction and for the invitation to kick off the spring series of architecture for health.

It's a noble goal to improve health.

And this topic has become more important to our country than perhaps ever certainly in your lifetimes, because our culture, our economy, our wellbeing have all been impacted by the pandemic.

Where you work, where you go to school, how you go to school have all changed dramatically, not once, but multiple times over the last couple of years.

And perhaps this pandemic has caused some people who never thought about architecture in their lives to give some thought to architecture.

We certainly, at least in places that I go that have nothing to do with health or architecture, find ourselves talking about where we work.

Are we going back to the office?

My employees say they just need to stay at home.

Thank you.

To knowing about things like airflow and air exchanges per unit of time.

I've put in almost 2 million miles on airplanes, and yet I had no idea that the air exchange was over horizontal pieces of the plane.

And so it's your three or four rows.

You don't care who's in the back row or who's in the front row, you just care who's in the three or four rows around you because that's where the air circulates.

Now, would you ever have cared about that five years ago?

I certainly didn't, but we do now.

We're building a new building at my church and I found myself saying, have you looked at the HVAC system since all this other stuff's happened, you know?

How many air exchanges have we got?

Have we got the capacity for special filtering?

Unfortunately, the answer was no, we haven't looked at it.

So there's a whole new level of understanding among people who are not architects, who don't necessarily understand architecture and its potential impact on health.

Now, when you combine the timeliness of the topic with the excellence of Texas A&M's College of Architecture and our Center for Health Design, it is truly a remarkable year for us because Dr. Pentecost has shared this with me.

2022 has been deemed by the International Union of Architects as the Year of Design for Health.

You put all that together, what a remarkable time this next year should be for all of you, certainly, but maybe for some of us who are interested more in health than architecture and see the interfaces.

Maybe some of the folks in our two extraordinarily rapidly growing cities and the communications we could be having about the broadest possible definition of health.

An auspicious time to be asked to kick off your spring semester of architecture for health, and I'll try to put at least a few topics out there in front of you.

And you know, I'm looking at notes and so I'm already skipping over things.

Architecture for health.

You guys have set a tremendous agenda for yourselves.

Over the course of the semester, which is already flying by, you wanna probe the issues, pitfalls, problems, opportunities and case studies in international, not enough to cover the United States, architecture for health practice.

You must be here everyday at lunch, right?

But so again, auspicious time to ask me to kick it off.

Now, when I look back at my multiple roles, I know if you look at the whole curriculum (mumbles) sometimes it looks like I can't keep a job, I just get bored easily, I think.

A little ADHD.

But it's been fun for me to look back and see how the different things I've done have taught me things that I assure you they didn't me in medical school, and how that knowledge has allowed me to do other things in medical education and healthcare.

And since many of your speakers for the rest of the semester appear to be coming from the architectural perspective, I'm gonna try to perhaps overemphasize the healthcare perspective.

So let me talk about health.

As a physician, I know a lot more about that than I do about architecture.

Now, I'm pretty sure in my early years, I never thought about architecture.

I practiced for almost 20 years in a little town outside of Houston.

My houses were already built when I bought them.

I might've complained about the architecture, but I didn't have a chance to change much.

The hospitals in which I worked did not ask me to sit down at the drawing board and offer my input to what they were doing, even though I was there when they built a new hospital.

The communities in which I lived, didn't come to me and say, you know, what could we be doing to improve the health of the community?

If they ever had that conversation, it was inside closed doors and didn't include the medical community.

I will say though, that I occasionally, and I expressed this verbally a few times, occasionally wished that I had an engineer or maybe an architect who could make rounds with me, probably muttering under my breath, what idiot drew it up this way?

There never was one, by the way.

Now, since I've been here, we've had conversations, but I've still never had an architect or an engineer make rounds with me and allow me to say, this is great and this is really dumb.

Maybe it's something we should be working toward.

I said the same thing though, about those architects and engineers from my kitchen at home, okay?

That perhaps the men who designed kitchens never cooked in them because there were an awful lot of things I would have changed there too.

So what would I have done differently?

Well, it's little stuff, like which way the door in the exam room swings.

If it swings the correct way, then if somebody starts to open that door and I have a patient unclothed there, that patient will not be visible until the door is fully open, and I have plenty of time to say, whoa, you're not welcome in here.

But if you open it the opposite way, you don't have to open the door very far before my poor patient who is unclothed is suddenly exposed to not only the intruder, but anybody else in the hallway.

Simple thing.

But unless you're used to sitting in an exam room with no clothes on, probably not something you think a lot about.

Sometimes there are bigger things.

You know, I spent my entire 40 plus years in medicine with people saying, wash your hands, wash your hands, wash your hands.

And then they put the sink in about the dumbest possible place to encourage me to wash my hands on the way out the door.

I actually proposed it one time that if you guys were smart you would attach the waterflow to a lock on the door, and if I didn't turn the sink on, I couldn't get out the door.

Nobody's done that one either, but you could at least put the sink someplace that it was easy to wash my hands on the way in and wash them on the way out.

There we go again, I need that engineer or architect to be making rounds with me so I could say that.

Well, then I came to College Station and as Dr. Pentecost said, I moved a number of notches.

Actually they called and asked me if I would consider being the interim dean of the college of medicine.

Had been some unrest there.

You've seen that in this university, right?

Where suddenly somebody's not there anymore.

And I said, absolutely not.

I came up here to start a family medicine residency program, which is kind of like practicing medicine.

I've done that for 20 years.

I knew how to do that.

I didn't know anything about academia.

But foolishly in the conversations, I said, you know, remember, I'm just a couple of years that point away from being the president of the AMA.

I've spent 20 years of my spare time moving up this huge organization.

So I thought I was gonna be safe.

I said, I am at best a medical politician.

And I said, sold.

That's exactly what we need here.

Somebody who can deal with the politics that are going on.

(groans) Really.

So I moved over to the college of medicine from the residency program and then had an opportunity to move to be president of Health Science Center.

When somebody suggested, I put my name in the hat, I said, I don't know anything about running a health science center.

They said you don't know anything about being a dean either.

So (audience chuckling) (Dr. Nancy chuckling) we muddled through.

We did some pretty good things while we were there.

But at that time, the Health Science Center was an independent degree granting university.

The college of medicine and a couple of pieces had been part of A&M, but the structure in Texas at the time was independent of health science centers.

And we lived on bits and pieces of A&M's campus.

So we thought we needed a campus.

It was a chance to kind of say to people, yes, we actually have health education here in town, and we are more than one building across the street from the vet school.

And that's when I got to know George Mann.

While the center for health design, it was a joint effort between the college of medicine and the college of architecture, it hadn't engendered the visible collaborations that we certainly hope might come, but George and I got together and he introduced me to the concept of studios and offered to have one of his studios work on the concept of a campus for the health science center.

Now we made it as challenging as we possibly could, because we said to them, we don't know where it's gonna be yet.

We're working on getting land donated and there's several different places it could be, so we'll just kind of give you an approximate number of acres and we can go from there.

Thanks to Brian Briscoe and Tina Pruett, because they found some pictures of their particular contribution.

But it was fascinating to me to have this group of students take the concept of what a campus, campus for training health professionals might look like, and then get down to the wonderful little miniature designs that you put together.

Seven of them that were very, very different, but very, very interesting.

They looked at everything from where you might put the buildings to what it might look like inside the buildings, but maybe the most important picture on this slide is the bottom one.

The opportunity for groups of very diverse people to come together and talk about.

Here's what we put here and why, and for we as health professionals to ask questions and to evaluate whether we thought they were headed in the right direction.

There were even a couple of these models that created space for the center for health systems and design.

Well, that hasn't happened yet.

Well, maybe it should, right?

We'll talk about that.

We kept those models for some time.

It was very motivating to us as we went through the then real effort of building the Health Science Center, which in case you don't know, occupies 200 acres over on Highway 47.

So I had a chance to become much more acquainted with architecture.

I participated in charrettes and other kinds of activities.

And obviously, I had the opportunity to have some influence in what that college campus looked like.

But about the same time, actually, even earlier than that, since the late 1990s, architecture has been really involved in the issues of health anyway.

In 1996, the Institute of Medicine published something called To Err is Human.

It rocked the medical profession with its declaration that somewhere between 40,000 and 100,000 people died every year as a result of medical errors.

Now 1996, and that puts me right there in the heart of it.

I was the president elect, and then the president of the AMA as this was hitting the papers.

Not particularly good for our press, because it implies that we're sloppy and don't care.

And what doctors wanted to talk about was, how do we get that number down?

Not how do we fix the errors, but just how do we change the press, okay?

Can you report 2,000 errors, not 100,000 errors?

And we had to change that message and say, the real question is how many of those are preventable errors?

And we expanded the conversation to lots of other industries.

So we had aviation there, because they had figured out ways to require that pilots report near misses before they became disasters and not punish the reporting pilot, but learn from the near miss.

We hadn't figured that out in medicine.

You report a near miss, the odds were good, you might get reprimanded to the point of an impact on your license.

We talked to nuclear power, because where they have disasters, they're really big disasters.

But architecture was right there at the table looking at things like, what kind of floor surfaces can we clean and what kind of floor surfaces might prevent falls?

The answer is, you don't want any of these throw rugs or people like me catch their toe and they fall down and break their hip.

They talked about things like air exchanges and infection, and ways to try to improve the flow of patients for noise control.

It turns out that if some place is really noisy, you miss some of the communications and you might miss a medication change, or you might miss the fact that Dr. Pentecost already gave that dose and I'm about to go in and give a second dose of the same thing.

So architecture had already been really tightly woven in many parts of healthcare.

Shouldn't be any surprise to many of us that in fact, architecture for health is a continued conversation.

Now about the same time, a second wave of philosophy was occurring, and that was interprofessional education.

That's something that the architecture for health series attempts to embrace by inviting healthcare people to come and participate in these lectures.

What the WHO, the World Health Organization said is that interprofessional education occurs when two or more professionals learn about from and with each other to enable effective collaboration and improve health outcomes.

Now, what they really wanted to talk about at that time was instead of nurses and doctors sometimes conflicting with each other, fighting over control or pointing fingers at each other, if we spend time learning together and from each other, would we perhaps have a more collaborative practice?

Same thing for pharmacists and social workers and others.

But that definition fits just as well for engineering, architecture, maybe even education.

Certainly it makes sense in terms of teaching the varied health professionals, because it's a team sport, or it should be.

Although there are times if you're in the hospital, you might think it's more of an oppositional sport as we see who can garner more points.

And certainly if it works for education, then collaboration outside the classroom is kind of the same thing, learning from one another, all right?

I learned a lot about architecture working with first, the college of architecture, and then with the hired architectural firm about what we could and couldn't do in terms of building campuses.

But collaboration makes perfect sense because no one of us can have all of the skills, all of the insights, all of the detail that would go into a city building or a hospital, or maybe a clinic.

Ray said that we have been working with small rural hospitals, which are closing by the way at record rates, leaving counties and regions without accessible health care.

How can we design a facility that is easier to financially support, offers the kind of emergency triage and stabilization that patients need so they can get transferred if necessary to a bigger hospital and still do it at a cost that a small group of people can financially support.

It's a fascinating question, one that I probably, I can tell you what the medical issues are, but I need people like you to come in and talk to me about how we can utilize spaces for multiple different things.

How we can quick flex from day to day clinic care to a multi vehicle motor accident.

Somebody coming in who's profoundly ill and not have to have space that sits there for days and weeks at a time, but that is desperately needed if you have that multi vehicular accident and several people are ill. Well, collaboration makes good sense for healthcare.

And as I said earlier, I'd often wished that someone would make rounds with me to see how I might make what I do easier.

There's actually a great article about collaboration that talks about architecture, working with an occupational therapist.

and the two who are coming from very different, The architect wanted to design something that was appealing and would attract people in, and the OT was saying, wait a minute.

This is a person who has ambulatory difficulties, maybe spending a lot of time with a walker or a wheelchair.

And how do we modify those spaces that you've made so beautiful, but may not work for the person who wants to be there?

It was very interesting as they talked about the OT dabbling in becoming kind of a hobbyist in architecture and realizing there was way too much to learn to make it just a little thing you dabbled in in the side.

But equally, most of you are not occupational or physical therapist, you probably can't address all of the challenges of people who are not fully functional in terms of all of the things you build, kitchens and bathrooms and egress and ingress for.

There's a process that architects commonly refer to as pivoting the room.

I really liked that topic.

I just happened to cross to this.

I was looking for remarks for today, but pivoting the room entails looking at a problem from the vantage point of all relevant professions and stakeholders.

I can tell you in healthcare, we don't always do that very well.

I hope you do it better in architecture.

In medicine, we say everything we do is for the patient, but if you talk to the patients, sometimes they feel like what we're doing is really being done for our convenience or for our effectiveness or our efficiency, and we hope that it meets their needs somewhere along the way.

Pivoting the room would mean listening to that patient and say, oh.

Oh, I see that's really not meeting your needs, is it?

I need to change that.

If I had another whole hour, I'd talk a whole lot more about why we need to pivot the room to listen to patients, but that concept's great, right?

You're sitting at the head of the table and you're there with your experts in architecture, but if you're effective, you turn that around and listen to the educators or the clinicians, or maybe the city managers and hear what their concerns are.

You don't just hear the noise going in, but you actually develop comprehension and it impacts where you're going to design, how you're going to design.

So what I wrote here was pivoting the room, it seems to say this, shh, listen to what others are saying.

Some of you may have had a mother who said to you, you have two ears, one mouth, use them proportionately, okay?

Many of us have trouble doing that.

But how do you teach professionals to get into the head of people who come from a totally different perspective?

It's a skill set that we don't necessarily have, maybe particularly because we tend to become educated in silos.

You spend most of your, at least your senior time in the university, in the college of architecture, not dabbling over here at the Health Science Center or at the vet school or agriculture, all right?

Likewise, once I get into the, at least the third year of medical school, I don't do anything but medicine.

I may complain about how somebody else designed it, but I don't spend any time thinking about how or why it was designed that way.

So collaboration is a good thing, and it's something that has been emphasized about since the same time as the patient safety movement.

There are challenges to that, okay?

The earlier the better.

If that OT had become involved after the design was already completed, it not only would have been very frustrating for the architect to say, what changes should I make?

But it would have been very expensive.

One of the things I learned building that campus was no change orders.

You'll destroy my budget, okay?

The church building that I have an opportunity to be mildly involved in had a decent budget for things that weren't planned, but 60% of the way through the project, they spent 90% of their contingency fund.

I'm going, whoa, you know.

Somebody needed to tell them, no change orders.

So let's work on our design we all agree on upfront so I don't have to come in and say, the door is swinging the wrong way.

The flooring won't work.

The counters are too high.

Who's the captain of the ship?

Now you guys probably don't have any issue with that.

Oh man, we do in medicine, all right?

Absolutely, it's a team as long as you understand, I'm the quarterback, I'm the boss, okay?

So tell me whatever you want, but at the end of the day, I'll do whatever I wanted to do.

That's not collaboration.

That doesn't work very well.

Different languages.

Boy, do we ever.

I can't speak for architecture, but I was at a dinner a couple of nights ago and I was talking what I thought was reasonably straightforward language.

I was talking about CMPs and BMPs and TSHs, and finally a guy at the end of the table said, excuse me.

(chuckling) Oh, hmm.

My acronyms mean nothing to you.

And turns out he's a businessman.

Happens to be in healthcare.

But even though he's a businessman in healthcare, those things are clinical terms.

He didn't know what I was talking about.

We have to learn enough of that language, or maybe we find other ways.

I speak very bad Spanish.

Any of you speak Spanish?

A couple of hands.

So if I walk into an exam room and it's clear that the people there speak only Spanish, I usually say, (speaking Spanish) Very little Spanish.

(speaking Spanish) Really bad Spanish, hoping they will take pity on me and use the English they said they didn't have, all right?

We need a little better translation level than that.

(laughs) So how do we get that?

There's a great story of a nurse who was looking for a career change.

She practiced nursing for a long time and she became a consultant to an architecture firm, and she said, boy, did I feel out of place?

I had no idea what I was doing at that table.

But a few weeks in, she began to say, oh, I'm kind of the translator here.

I understand what those clinicians are saying, and after a few weeks, I can talk to these architects.

I may not know their language yet, but I know enough of it to begin to make the connections so that when you listened, you could understand what you were hearing.

So maybe we need translators rather than each of us expecting that we can dabble in one another's fields to the degree that we need to actually collaborate.

Different viewpoints.

Back to that OT, function versus design versus appearance.

You know, I love beautiful architectural design.

That may not be where I need to spend my money if I have some real functionality needs that are there.

So well, interprofessional collaboration is a wonderful goal.

There are challenges to making it happen.

(sniffles) And if you wanna talk about interprofessional education, there are even more challenges.

So about 10 years ago, each of the health professions has their own accrediting body.

So medicine has one and nursing has one, and pharmacy has one.

And each of them said, interprofessional education.

This team education is important to us.

It doesn't happen very well, all right?

We have different schedules.

Medicine starts in June, nursing starts in the middle of August, pharmacy doesn't start until about the same time you guys start in the fall.

Oh, wait a minute.

We're already, you know, a way into this year and you want me to start my medical students coming to some kind of an interprofessional class.

Doesn't fit my fit my calendar.

We have curricular challenges, okay?

I've got too much to teach in medical school.

I can't give you a chunk of time to learn about architecture or nursing or social work.

I mean, I can't teach everything I need to in medicine, let alone all those other things that might touch upon people.

Now, I know you never see this in this part of academia, okay?

But sometimes we have people who actually think that what they're teaching is more important than anybody else, and so writing the curriculum has to be done absolutely to their I's and T's, and they don't care about the other professions you're trying to slide into that curriculum.

So you have to agree on common purposes and goals.

You know, I've actually seen where it only takes one or two people.

A dean, maybe a significant professor, who doesn't buy into the concept and is able to throw enough wrench into it that it may appear on paper, but it isn't really happening.

So there are challenges to collaborating, there are even more challenges to interprofessional education, but there's absolutely no doubt, all right?

That it works.

That we're better together.

That we're better when the people who are gonna use the building have plenty of time, not just to tell you what they want in the building, but to understand how you're drawing that into the building.

Now when we were building the Health Science Center campus, you had to realize that medical education had been changing rapidly for several years, and will continue to.

Don't build it too rigidly because how we teach medicine 10 years after we open that building may look totally different.

So how do you make that happen?

We used to just give lectures and people had to spit it back on exams.

Now we do a lot of group teaching.

So when we put tables and chairs in, we put two sets of tables to a level.

So you could turn around and talk to people rather than having tiers, where the only people you could talk to are the people on each side of you.

Little things, but important kinds of concepts.

You need to talk together.

Certainly, there is little doubt that we are better together if we can talk to each other, if we can learn those languages, and if we can learn to listen.

Now, there are those who would say, okay?

That we have a great deal of just way to go yet to get to the horizon.

That it is a nice language, but we haven't gotten there yet.

But I would say that in fact, we have made huge progress.

Oops, let me go back.

There we go.

That if we can learn to collaborate, or maybe I should say where we've learned to collaborate, positive things have happened.

And I think Texas A&M not only has already done a fair amount of this, but some of the changes that Dr. Banks are bringing suggest that she's pretty committed to doing more.

Certainly, architecture and health, but all kinds of other collaborations.

If you think about the possibilities and you realize that we have really pushed for increasing diversity in the students and the faculty, because we've proven that increased diversity increases the capacity to learn from one another, then it makes good sense that you increase the diversity around that table if you're gonna pivot and ask different people what their perspectives are.

Well, in this Year of Design for Health, I consider that kind of an invitation that though it may feel like the goal is way out there on the horizon, this year is an opportunity to take advantage.

You know, anytime there's press about something, you're gonna get a little more bang for your buck.

And gee, we've got somebody here who's right in the middle of that design for health year, and we have an award winning highly ranked health aspect of our college of architecture.

So we really ought to have a huge voice in some of that.

You know, when I think about it, WHO says health is basically having wellbeing in all aspects, from psychology, to your physical wellbeing, to where you live and practice.

So, you know, you can think about things like terraces or patios for those of us who are dumb enough to keep coming into the office so we can step out and get a breath of air.

That's pretty standard.

Gardens to promote peace and tranquility.

I assure you if you're in a hospital, it's not peaceful and tranquil.

The ability to step into a healing garden can make a difference for those patients, or at least get them away from some of the noises they hear inside.

Spaces that create connectivity.

You know, Bryan-College Station attracts Aggies to come home.

So we have a good size retirement or nearing retirement population, and people live until they're 80, 90, increasing numbers that live to 100.

How do we design those living spaces, particularly for the octogenarians and above so they have connectivity?

Do they have to drive to their doctor's office every time they want a blood pressure check?

Or could we build something in so that we as physicians have early warning that things aren't going particularly well for the patients, and maybe we intervene before they have to call 911 and go to the hospital.

Some kind of connectivity between where they live and their providers.

Now I say that and then I think, I don't want my scale attached to my doctor's chart.

I might get calls I don't wanna have, okay?

Maybe I don't even want my blood pressure cuff connected 'cause I might be selective about which blood pressure readings I send into my doctor, but certainly, it's something to think about.

How about hospitals that allow professional staff to do what they need to do without stripping the dignity of the patient?

Again, we're back oftentimes to what's most efficient for me, not necessarily what serves the total wellbeing of my patient.

After all, I'm gonna fix their cancer or prevent their heart attack.

I mean, their dignity should come later, right?

Unless it's mine.

Certainly, the role of the built environment.

You know, I don't think of that with architecture, but it is, and it impacts so much of what we do, but it's also transportation, and it's creating spaces.

The only clinical work I do right now is in a free clinic.

So these are the poorest of our citizens here in Bryan-College Station.

And when I say, I need you to go exercise, and they look at me.

And I said, do you live in town or in the country?

It's actually easier if they say the country, because those roads are less well-traveled and they're probably safe walking on the roads.

If they live in town, they often say to me, I can't walk on those sidewalks.

They're not even.

I'll trip on the cracks.

They're not safe, I'm not sure.

I had a lady the other day who has a four year old.

It's granddaughter she cares for regularly.

And I said, that four year old would love to take you on walks.

She said, I'm not allowed to take her outside.

Why?

Because her daddy may come steal her away.

So I keep her in the house.

Now, I don't know how architects can help with that, although a fence around the backyard might help, but there are all kinds of things about the way we live that prevent people from having healthy lifestyles.

And I'm not talking about having to go to the gym, I'm talking about going outside and walking fast enough to get your heart rate going a little bit.

And we need recommendations about HVAC systems so that when the next pandemic comes along, may it be another 100 years, we don't have to worry as much.

We don't shut down our economy.

We shift and change, but we deal with what it is.

There are so many things that go into the concept of health and you're all about design.

I just think it couldn't be a better time.

Well, in spite of our best intentions to create a interprofessional learning environments and collaborative practices, we're not there yet, but I think you guys are headed down the right path and can show some of the rest of us how to do it.

So let me finish with a quote that I found and dearly loved.

Winston Churchill said, like a lot of quotes.

I think he actually said.

Who knows?

"We shape our buildings and then they shape us."

Now he extensively said that at a time that the Germans had just bombed the House of Commons, and he understood the power of a building.

So the question wasn't, should they rebuild the House of Commons?

Of course, they were gonna rebuild the House of Commons.

It was, should they build it back pretty much the way it had been modernized perhaps, or should they do a totally different design?

And what it said according to Churchill was, the building was the vessel that held echoes of critical debates.

It held the vision of freedom, the hope for the future, the very soul of the nation.

Oh my goodness.

How could you hear that and not rebuild it?

Much the way it had been.

And in some ways though, unfortunately, nowhere near as poetic George, that was how I felt designing the health science in the campus.

I wasn't gonna be around for 100 years, but I wanted a campus that when people came, they went, oh, that is a nice campus.

You've all been on college campuses, some of which you go, hmm, and some which you go, wow.

I wanted a wow.

I love those buildings that have inspiring quotes on them.

Hmm, they're very expensive.

We don't do that much anymore.

So how can you get close to that?

I wanted it to be obvious.

These were buildings that were not just glass and concrete.

They were gonna be classrooms.

These were buildings where transformation occurs.

Where young men and women came and they went from being students to doctors or nurses, or dentists.

Unfortunately, not architects, we don't teach that over there, but I wanted it to have a feeling that when they came back, they were imbued with some of that same sense that Winston Churchill was when he said, you know, the very soul is here.

I believe, all right?

That teams who can listen to each other are more likely to make that happen.

And I challenge you not only in this year of health design, design for health, but across your careers to keep in mind that some of what you do is very powerful and it's gonna speak for a long time after you're here, and that you can probably make it more powerful if you learn to pivot the room and listen to all the players as you get ready to, I guess you don't draw out pencils anymore, you pull out your computer, but whatever the equivalent is.

So thank you for letting me come and kick off the spring, and I think I've got a few minutes left for questions.

(audience applauding) Thank you.

(man murmuring) I answered them all already.

(man laughing) (man speaking faintly) Yup.

Yup.

(man speaking faintly) Right.

How do I think planning and collaboration is gonna look in the future?

I think that we have become more comfortable with virtual interactions, and that speaks for the capacity to have people at the table that are not in town, all right?

I haven't traveled for two years, I suspect most of you haven't done much either for two years, and suddenly I have two or three trips I have to make and I'm going, wait a minute, you know.

I don't really wanna pack a suitcase and drive to the airport and those sorts of things.

So I think that we'll take advantage of this new found comfort with dealing with people virtually.

I think that the problems are not whether we get you in the same room or do it virtually.

I think that we still haven't crossed that big boundary of why do you have to be at the table?

What have you got to offer?

And that's a hurdle we're gonna have to find a way to convince generations that in fact, I have something to bring about education or about healthcare, and somebody else has something to bring about childcare or community.

So crossing that hurdle will change the planning immensely, I think.

- [Man] Does that (indistinct) She said, thank you for your comments on the environment, especially in the discussion on (mumbles) - Thank you.

I think the environment's gonna be increasingly important.

Your generation more so than mine has really embraced the concept that life is about more than getting up, going to work and doing that for 50 or 60 years, but at the same time, you don't wanna just go home and play video games, right?

We need to create environments that maybe allow you to do part of your work in a more pleasant situation, or that are healthier for you that allow you to interact with people other than the folks you work with.

And I love the stuff I've read.

I don't know a lot of places doing it that are talking about the value of community.

You might have 20 communities or 50 communities in Bryan-College Station, but if you began to build around the concept of people ought to be able to walk to a grocery store, people ought to be able to easily get to the church, not have to get on Highway 6 and deal with the traffic, then you've got a healthier community in general, but I suspect that in your four or five years of architecture, there's no way you can cover all of those issues.

So it truly is a matter of, as you define what part of architecture you wanna do, figuring out who those people are that might have insights that you don't happen to have, that you haven't been privy to learning.

Yes, sir.

- [Man] Have you ever (indistinct) (clears throat) like a specific design (speaking faintly) - Oh, lots of them.

You know, one that has just been overwhelmingly present in medicine is, 40 years ago, probably 60% of the beds in hospitals were semi-private, two beds to a room.

It was a cost issue.

And only if you could afford to pay extra, did you get to go to a private room, right?

So why now do you go into a hospital, and I'm not sure you can find a semi-private room, right?

Well, it had nothing to do with costs, and well, patients used to comment about the lack of privacy, the lack of dignity of having other people share everything that was happening, okay?

It was all about infection, right?

But how close you have to be to other people's both misery and conversations and so forth?

You hear a fair amount of it in terms of waiting spaces, okay?

Again, it's back to dignity.

You know, we put you in a gown that has no back.

It's very efficient for us, okay?

Not very nice for you.

And then we wheel you through the quarters and we say, yep, you're due for your MRI.

Mm, they're running a little behind so you'll be, you know, it's cold, there's nothing to do, and you're sitting there with, you know, your open back to gown as you sit in a wheelchair.

Could we not design places that are warm, friendly, maybe they have magazines, or I'm not sure you can go anywhere anymore that there's not screens (laughs) that are entertaining you.

So it's those kinds of things.

There's a desperate need, and you hear it from families that are deeply troubled.

If you go into emergency departments, probably only about half of them have built-in private spaces.

So if I have to come and give you really bad news, is there a place I can invite you and your family out of the big, open waiting room and give you bad news where you're a little bit more private, where if you're gonna cry, or if you're gonna break down, you don't have to share it with whoever else happens to be sitting there.

Little things, okay?

But they can sure make a difference in terms of, not what happens to your health, but how you perceived it happened to you.

- [George] We probably have time for one more if anyone wants to- There's one in the back row.

- We have one.

Please.

(woman murmuring) - So the question is, how do we learn one another's languages faster?

I think probably the best answer to that is translators, okay?

To identify people who, for whatever reason kind of had one foot in each camp.

Maybe it's a doctor or a hospital administrator who's built multiple institutions.

He may not be any good at building them, but has learned the language of how to talk to the architect.

It maybe an architect... Well, let's take the nurse who was looking for another career, okay?

And began to work in an architectural firm.

So finding translators may be the fastest way, but I think the other way is kind of like learning any other language, you have to want to, you have to listen and say, wait, wait, how do you say this in?

Or what do you in your profession call this so that you may not be as good at it the first time around, but hopefully the third or fourth time, fifth time you in fact are better.

And if each of you bring a little bit of that, now you have multiple translators.

You can probably get to the point you wanna be.

Again, thank you.

What a delight to spend some time with you today.

(audience applauding) It's all yours.

- Thank you.

Nancy, that was fun to listen to.

Thank you so much.

- [Dr. Nancy] Oh, thank you.

- Next week, I have a special presentation.

Nancy mentioned the Year of Design for Health.

Next Friday morning.

(chuckles) We're not gonna be here, don't come, but Friday morning early in this part of the world at 7:00 a.m., two o'clock Paris time, the World Health Organization and the International Union of Architects will come together for a joint conference to launch officially the Year of Design for Health.

Terribly exciting.

And that will run probably about two hours.

The connection information for that is going to be distributed in case you want to join in.

Anyone can join.

Anyone is welcome to join.

But following that launch event, which will feature several keynotes, some panel discussions with people that have a lot to offer.

Following that launch, Xipong Lu, who is here with us and who is working with me, actually without whose help most of what I do wouldn't happen, so Xipong, thank you, my good friend.

But he and I are going to be involved with that event, and we will be bringing in this hour an update on that launch event.

So the launch will happen officially, Texas time, 7:00 a.m.. Come here at 12:35 and we'll provide you the latest greatest update on what happened only a few hours earlier to herald the launch of the Year of Design for Health.

Pretty exciting time, gang.

Timing is perfect.

Don't miss that.

We're gonna bring you the update, it's gonna be a fun year.

Thank you for being here today.

Thanks again to our guest, Nancy.

It's always wonderful to see you.

And that ends it for us today.

Thanks so much.

(audience applauding) (upbeat music)