- Good afternoon.

Welcome to the Architecture for Health Friday Lecture Series.

It's great to see you all here in the studio.

Those of you joining us online, welcome.

Great to have you here.

Our speaker today is Fernando Rodrigues.

Fernando is a vice president and senior health planning official, principal really, with HDR.

Fernando has about 25 years experience in health planning, in the healthcare industry, projects of all sizes and shapes and kinds in a variety of countries.

He's built a reputation for being innovative, blending building information modeling with simulation tools to create some efficient, flexible, powerful solutions for clients.

Fernando is board certified by the American College of Healthcare Architects and he is board certified in evidence-based design by the Center for Health Design.

What that really says is that he appreciates the power of research to create efficient, powerful, high performing solutions for his clients.

Fernando, it's a great pleasure to have you with us today in the studio.

Please join me in welcoming him.

(audience applauding) - Okay.

Thank you so much.

Howdy?

- [Audience] Howdy.

- Learned to say that.

I'm very happy to be here, especially in the Ring Day, which is I know, a very special day for all of you.

Someday I'll hope that I can come here and get my ring as well.

Well, thank you Ray, for the introduction.

As many of you know me, again, they know that I am international architect by nature.

I was born in Madrid, Spain.

I am Portuguese by heritage.

I grew up in South America, went to school in Venezuela, and these days I'm a proud US citizen.

So that I believe, are the credentials to be able to talk to you about international architecture and goal and perspective, is something that is our passion across this building time that we all love.

I wanna start and stay on this photograph because probably that is in essence, tell us what, for me being an international architect means.

This is the dedication of one of my most recent projects.

It is the Champalimaud Pancreatic Cancer Center in Lisbon, Portugal.

And this picture is very important because in this picture, all you see is the essence of international architecture.

In this crowd, and listening to this group of people that I will start with lady on the right, she's a French donor.

Next to them are the Queen and King of Spain.

Then we have the President of Portugal, and then the other donor is from Spain.

They're talking about the importance of this building in the research and seek of a cure for one of the most deadly forms of cancer.

All I think that's important is they're talking to the top 100 most important researchers in oncology that were invited to this ceremony.

And that was my seat and they were all talking and celebrating this building that I had the chance to participate and contribute in the design.

As Ray said, I work for HDR.

We are known for doing very complex large facilities all over the world.

I have had the opportunity working on many of them.

Most of my work is along the lines of academic type facilities.

And that leads me to the reason why we are here talking today.

So this is one of my favorite statements that I hear all the time.

This is usually what, in the first encounters with my clients, they always say this, "Listen, Fernando, that's not the way we do it here."

And you can change here by any place I have worked with in Portugal, China, Singapore, or any place in South America.

And then how you come out of that conversation in a very responsible way is very important.

Usually my first reaction is that if you say that, probably you should not have hired me to come here and talk to you today.

And how you then offer to create a dialogue out of that first statement is very important.

So what I would like to do with you all today is to really go through the aspects that actually make us be very credible, very responsible, and very accountable about the knowledge that we're gonna share with our clients all over the world.

Because, I think the essence of health architecture is a global idea and I think it's very relevant across cultures, places, and countries.

So this is what I do, We focus on knowledge transfer, so like working bees, we have the responsibility to bring the pollen from one country to the other, the best practice, the knowledge and really make that our daily work.

That's what I do all the time.

That's an aspect of my career that I feel very proud and taking on that role in a very, I would say, responsible and accountable way.

To do that, I think that the idea of establishing a conversation about best practices and how best practices can be brought across borders is something that we have to be conscious.

Again, is there a way to say that best practices, that you can transfer best practice from one country to the other, to one client to the other, to one hospital system.

Is something that certainly offers part of where we need to start growing.

We all know that the world is very different, when we look at population, when we look at number of beds and length of stay.

We know that all the different countries that we work in have different parameters, that their challenges are different.

That the way that healthcare is delivered is different, but in the end, the idea is to create solutions and concepts and ideas and best practice that it can be applicable to all of them.

So care expectations.

So first thing, we go usually to talk to our clients and the care expectations are very different.

The way that a patient talks to a doctor, the way that a doctor talks to a patient everywhere we go, that dialogue is completely dissimilar.

Again, something that always hits me when I work overseas is that in the cycle of care of a patient, how many times probably that patient has to visit or have an encounter to receive care.

We go to places in Europe, it's very normal that a patient goes to a doctor one day, the next day has to go to the lab, the next day has to pick up the lab results, take it back to the doctor, go to the doctor, then the doctor offers another order to an x-ray.

The care cycle usually takes a lot of time and patients are okay with that.

Others is about the encounter time.

It's very difficult to create benchmark times to actually utilization of rooms when a patient in a specific region is expected to have a long dialogue with the doctor and is probably often not expected that a visit will be as focused and short as some chance, for example is here where where we want to go to the doctor, get in and out in the shortest time as possible.

So that's a typical discussion.

We go there all the time, probably the first reaction that we see often.

Let's talk about environment, correct, the patient room.

We go to different places of the world and the patient room offers kind of initial discussion, should be private, should have or not how many beds, without getting into many details in terms of toilets or the toilets.

Those are elements that we all need to really consider that are gonna be different.

And then we need to have an answer and usually the answer of expectation that we have is not gonna be right in that conversation.

Intensive care probably is one of the process of care where we find the biggest type of discordance.

Like in the US we are now seeing private rooms where visitation is allowed for families with full size toilets and sometimes even showers.

Those ideas when we try to translate that type of environment to other places that probably are not compatible with the way the care is delivered, let's say in China or let's say in some places in Europe where the sepsis or the expectation around the patient room or the patient is in ICU care is very different.

Talking about having a family member that has ample visitation or free visitation in those areas usually are aspects that are absolutely out of the question.

Even the idea of creating a room with four walls and a door to care for patients, especially in ICU environments are an aspect that doesn't really translate to country to country.

So we need to be very aware that the processes and the care model is to be expected to be different and that we need to certainly design according to those parameters.

Ambulatory care is an area where certainly it's also very different.

There's ample growth on the day hospital concept, a lot of care these days is given in environments where patients go there and stay and receive care for long periods of hours at say, infusion is one of them.

And that's an area that changes quite significantly from country to country as well.

We also have to consider of course that local regulatory licensing requirements.

So codes and requirements are very different.

So how do we actually implement or propose operational models that are compatible with the regulations is something often a challenge.

We sometimes go to countries where licensing requirements are very limited and the absence of those sometimes offer all kinds of challenges.

Sometimes we go and have a discussion about should we bring licensing guidelines like FGI and design that project according to those with the understanding that at least there is gonna be a guideline and a document that we can actually do checks and balances in terms of requirements for the facility.

And at last is the cultural and environmental differences.

I think that this picture represents for us a dialogue that I had recently about that project in Portugal when we were actually always creating an environment where patients look to the outside and the client forced us to realize that, well, you know what, really when you look outside, you always looking and the patients are seeing you as a silhouette.

Those are reflections that we have never encountered in terms of environmental perspective of how the spaces are used.

And since that conversation and realizing that that is the way, I personally have stopped to actually create zones for families that are actually back to the window because it's true, patients are there.

The glare, the environment, it creates some... And those ideas come after a realization that some people can bring you some expectations that where the places that we work our standard always expected orientation of areas.

So is there a universal approach for health?

Now we're gonna talk about probably, we talked about the differences a second ago, what is gonna be a process that is going to allow us to gain credibility in that dialogue?

Can we actually establish some references?

Can we start to create some parameters, some framework that actually allow us to speak with credibility in all these regions where work becomes an opportunity?

I often relate this to airports and the idea of universal design for me has a very strong reference on airports.

For those that travel for business or pleasure, the idea that you look at a picture like this and you immediately recognize where you are and that recognizing where you are offers you already in your mind a way of how you have to navigate that process.

You know that you're gonna get to the airport, you're gonna check your bags, you're gonna go through security, you're gonna head to a gate, all those elements are somehow in your mind and you already can almost create a sequence that is gonna inform you.

Wheres when we have the problem is when we get to that airport where check in is below and the bags are delivered on the second floor, so creates those type of different environments where we start asking the question, So is there universal approach?

Can we start understanding healthcare facilities?

In the same way, can we have more clarity about how we access, where we receive care, that the expectations are similar, that the level and the processes in the back are more standardized in terms of what will be universal approach to what is best practices.

And I think that that's one aspect where I try to bring to the table is there a place where the conversation starts to be common?

We know that we are all facing very common problems across all over the world.

Not only the care is changing, it's moving from inpatient to outpatient, but now these days we even seen patients to be remotely cared for or even that interaction in the exam room to be very, very different.

And that dialogue, what every time we go to... That's really the problem.

We go there, we talk to clients and then yes, absolutely.

Another one of course is disturbing technology.

Correct?

The disrupting terminology is everywhere.

Everywhere we go that doesn't matter, everybody the phone is their hand.

The idea about transportation is changed and the idea of... And that is a common trend, no longer aspect that happens in one region of the world and not in the other.

And so it's disrupting the whole system of care everywhere.

So there is opportunity there to have solutions because that language, that problem is universal in nature.

Certainly everything is evolved.

The environment itself evolves around that, the patient expectations are changing but are changing and in my opinion, to a certain extent, they're getting normalized.

The care rooms and the way that we configure rooms are starting to reflect more commonly these operations, again, we've seen a probably a convergence in the way that we understand facilities all over the world because often we go to places and clinicians are trained in a different country, they are referred to that facility or that process.

and that's how the dialogue starts to be actually very constructive.

And where the reference is and the opportunity to offer solutions comes into play.

Certainly, we're trying to develop tools and tools that actually start to measure what are these differences.

This is an idea that started a few years ago about trying to place different processes and different elements that we look at in our facilities and try to place them and measuring, grade them in terms of where they were, where they are and where they want to be in terms of closer to an international design or something that was more traditional to the region that they are.

That has evolved recently.

And what we have done is actually creating a very robust database system.

Right now we have about 45 projects, mostly of course in North America, but with a few already in Asia and all the way to Australia.

And what we are doing is trying to actually create a qualitative and qualitative benchmark.

The lecture is going to start to help us to really inform us on what are the references, what is common, and we are trying to finalize, really eliminating the need for the rule of thumb.

That is gonna be probably the biggest breakthrough for us when you no longer have to talk about references of what you think, but actually using data to actually back up our decisions.

Again, this is just one of the different aspects that we can start measuring, but in this case, square footage per bed, is conversations like that, that actually inform us not only by region but by type and by what are going to be probably the solutions more adequate for that specific client, for that specific region, for the recipient building type.

And again, this is just one of the elements, we compare regions, we compare countries, we compare models of care and we even grade them.

We even have the system is able to then establish quality measure elements to really say this is the type of project that we should look at in terms of establishing benchmark and best practices.

So out of that conversation, there is a different, there is something that is happening and the idea that designing international work is gonna happen everywhere.

So while we can say that we architects, US based architects are going to start to do great work in other countries, that has been probably the trend in years back.

What we are seeing is that we are creating partnerships with architects from other parts of the world, even to deliver work in the US.

I usually say that they're very great architects, they can do great buildings, there are challenges that they need to do great buildings that are also great hospitals.

And to do great buildings that they are great hospitals, they need people like us and include all of you as well in this conversation is just because that's what is required.

I'm gonna show some examples of things that are happening.

For example, this is UPenn Penn first in Pennsylvania.

This is a project that we are doing with Foster and partners and comes out of a global partnership.

So this is international architecture happening in the US.

This is a firm that brings a global perspective of architecture that is paired with another US based firm of the same caliber and produces architecture to the level expectation of the client, but deliver in the US.

So I call this international architecture as well, is a global approach to architect even though happens in our country.

Another example is the work that we are doing with Herzog de Meuron in San Francisco.

Exactly same formula.

We have to acknowledge that it's an opportunity to peer design as well as health design and create very strong teams that can deliver buildings of a caliber that are expected in this country.

Another example is, this is the project that you saw in the beginning of the presentation.

This is the Pancreatic Cancer Center in Lisbon.

In this case is HDR and Sachin Agshikar is an architect from India and you have Indian architect, US based firm working in Lisbon to deliver a project, as I said for a Portuguese foundation with money that comes from donors from other countries.

So again, the idea of globalization of international work, my opinion is taking these days a complete different approach as we're talking about global architecture delivered everywhere without really aspect of border.

So is really a dialogue and I think it's enhancing significantly the quality of what we always expected that our building infrastructure needs have to be.

Okay, let's talk about how we, US based firm delivers work overseas.

And I think it's different for everyone.

But again gets into a little bit about the things that we try to do to be able to succeed in that business because it's very important that we all consider that we are a business and to do successful work overseas, there are many, many, many challenges.

You need to pick the markets where you can be effective, the markets where you can actually deliver work, the markers where you can be responsible for the work that you do and the markets where you actually can expect that the quality of the work that is gonna be built is also based on your expectation and the level of quality and effort that you put into it.

Know your client, really do a good understanding of the opportunity.

The expectations, it is or not a client that you can really work for.

Can you offer value?

I think the idea of the contribution is gonna be very important.

Again, this is the reference of the client in Portugal that their mission in terms of what they do or they try to achieve is very similar for the type of clients that we care for in probably in the US in major markets.

So that opened the door for us to understand each other.

And really avoid that first question about Fernando, what are you doing here?

The client becomes your number one fan over time.

Again, ending on that idea of when you have the king of Spain and the president of the country of Portugal, really cheering the team that was behind delivering that work is an incredible moment.

I think that making sure that you offer a great team, a team that can work together, a team that offer the right skills and the tools is critical.

Doing work overseas, I believe starts with the creating a great team, I think is very clear that we have to rely on local entities, architects, engineers, contractors that are going to deliver our work.

Most of the time we don't have the professional license to deliver work in other countries.

So we cannot be what we call the architect of record.

Our contribution and liability is very limited in terms of the risks that we can assume in those countries.

Also, as I said, we need to make sure that we deliver work within the parameters of the returns that everybody expects.

So this is actually the team deliver the work in Portugal.

Again as a multinational team, people from different places and for a successful delivery there.

I think the other thing that is important is establish credible expectations.

I think it works in both ways, correct?

Each country that we go and work with, again, the idea about schedule, the idea about budgets and all that are usually a big element for discordance.

I think at working or making an extra effort to make sure that there is an alignment in terms of expectations I think is very important.

And at last, as I said, offer value.

Again, the client goes to you to deliver works overseas because they need something that you know.

And I think that in this specific project, they came to us because they were looking for a firm and a group of people and a team of people that had the knowledge to deliver a building that have very unique conditions.

This is the first building of this kind where also the diagnosis, the therapeutics, all the components of care and even the science labs were all combined within the same building for one specific form of cancer.

We were talking about the super specialized cancer center, a new trend that probably we are gonna see more and more of these type of buildings as the idea of bio convergence comes in where we are bringing care and science and now even the therapeutics itself being produced within the facility, that's what a CGMP lab is, is a place where they do the expansion of the T-cells so they extract for tumors and then transform that into the superpower cells and then reinject back in the patient.

With that said, when we get to this point, I always say, let's go get travel, let's travel, correct?

Let's look at some projects that HDR has done, probably let's point to some differences.

Let's take a look at some ideas and we're gonna do that for the next probably nine minutes.

And then after that we'll open the conversation for questions.

So we're gonna start in Australia.

Correct?

And here we would like to talk a little bit about the Chris O'Brien Lifehouse.

I think it is a very, very beautiful building completed about three or four years ago I think is focused on cancer care and is a building with beautiful interiors, beautiful connections of space, nature and places for care.

We have their patient rooms all private, the model probably more like the ones race tracks that we were designing probably 20 years ago here in the US.

Our benchmarking database starts to produce information about specifics of the metrics of the project.

But single private rooms, smaller rooms that typically we see, probably in more minimalist in terms of nature and also elements around the room, around the patient.

But as I said, a lot of attention to the expectation of the experience of the patient, access to nature and again, balconies I forgot to mention that.

And the possibility of the patient to go outside the room.

And those are elements, as I said, if I said have this conversation probably in other part of origin of the world, they first say, Fernando, that's not the way we do it here.

But certainly that's the way they do it there.

And I think that creates beautiful opportunities to care for patients in a different way.

So having the dialogue and understanding if that is something that could be applicable to your context is an idea.

So let's go to Europe, go to Germany.

This is the project in Eisenberg where we see a building, the round building in the center number 13 with a very peculiar arrangement in terms of architecture is a racetrack, but all the rooms are perimeter, just single loaded corridor.

And of course also the architecture are heavily impact by the requirements of daylight access that are required in Germany that are very different than what we have in other parts of the world.

But that offers an opportunity to create environments that are very different.

Here also the fact that a patient room with two beds and we know that we no longer can do those in the US, but over there we have and many other parts of the world is a perfect standard.

But again, an opportunity for the patients to have a common area in the balcony and space for families and have access to the outside while they're receiving care.

I think it's very home-like environment for what we see here and it's a different environment.

Let's now go to far east, go to China and see other types of projects with them.

This is Concord Shanghai Cancer Center in China.

Some places we see potential for rooms with more than two patients, not only in China but probably in Asia is probably the only place we still see those.

One of the aspects that we have is very strict expectations in terms of where the beds face and this case beds tend to not face North.

Is a very large building with sits on a very large podium that has partially underground, a lot of opportunities to bring natural light, but probably the type of building that will not be able to be built in those conditions in other parts of the world.

We had some challenges with making sure that we comply with code requirements.

There were fire access, so we have our building that needs to see flush with the podiums.

We also know that there are some requirements in terms of the south facing patient rooms that require a minimum of three hours of direct sunlight.

So those are the requirements that we don't see in other places.

And then most of the time in Asia we deal with other components associated with civil defense and et cetera, that make the buildings very complex and tend to be underground.

So we have actually care areas that if necessary would be placed away from.

Lets go here.

Some pictures of some renders of the design interiors, a lot of opportunities in terms of creating beautiful interiors outside of what is gonna be probably a typical hospital standard.

This is actually a completed project in China, also that is a children's hospital recently very successful in terms of the dialogue between architecture design and the care model that we need to apply there, very beautiful interiors, very tall atriums for example.

Those type of atriums are out of a question for US based projects where we cannot have that type of vertical openings or very expensive to do in terms of the requirements for life safety in the US.

But when it comes to patient rooms, again, we have patient rooms...

Patient rooms are private rooms that are adaptable to the same handed.

Those were ideas and concepts that were not acceptable if we go there and say this is what we wanna do and they immediately tell us that's not the way we typically do things.

But we have a client here that has implemented some of the concepts that we strive as best practice and have created a very beautiful building that as I said, very successful and is winning a lot of attention and prices for us.

We can go to the Middle East, Cleveland Clinic in Abu Dhabi, very large facility, here is where we can see probably the luxury and the availability of resources to be applied into the interiors and really creating some incredible public areas.

Certainly there is a different distribution of resources in a hospital like this where the money goes into public spaces more than probably in other care zones.

But again, in the end when it comes to the medical planner, the need for the space there is...

This is an example of an exam room.

We're certainly trying to understand how to hide those elements that in your face, make them look like a clinical space.

Beautiful interiors, also a lot of attention to try to hide the clinical components of patient rooms.

And yeah, let's take us here.

I know that short of time.

So the project in Portugal is for a future invitation.

- Oh good, good count on that.

Thank you Fernando.

No surprise.

Beautiful work, beautifully presented.

Thank you for being here.

Are there questions?

- May I?

- Please, please do.

- Fernando, wonderful presentation again, never disappointed.

And my name's (mumbles) Lu, I'm the associate director for the Center for Health System and Design.

So we are so fortunate to work with you four years ago, got time fly.

On a children's clinic project.

I remember we visited your Houston office and you were serving as a great mentor to the students on the whole project.

We were also really excited to learn, you have the great depth of the knowledge in healthcare design and also the international experience.

So you have saw all the fantastic projects that you have done.

And for the audience, our student here, they just started to learn design for health or healthcare design, what kind of suggestions you may have for them to start the healthcare design project and what they could start the journey.

Yeah.

- I think that probably, I said a few times during the conversation today, the language of health architecture I think is a global language.

And I think that offers a great platform to actually learn, obtain knowledge from any source around the world.

I think that that is in my opinion, it elevates this dialogue to a place where it needs to be wider understood, and actually offers a purpose for the healthcare architect.

I think that the notion that you can design with a purpose for me is certainly something that is a great motivator.

The other aspect I think is very important is yes the complexity, the idea that you, the challenge I think is an element of creates passion for those that are motivated for that type.

And then the idea of is a form of architecture that benefits of innovation, and is a form of architecture that is constantly evolving where we are having to work with the smartest people in the world.

Again, the fact that you have to create environments to allow for caregivers and the work and the forefront of all kinds of care, but these people is super smart, super devoted to their profession and you can actually share thoughts and ideas with them.

For me is what makes me be a healthcare architect and if those words motivate you to become one, I think that you'll find a guidance and a passion to care for the rest of your career.

I had the chance to encounter myself in the situation of many, many years ago by chance start working with a firm that did healthcare and those words coming out from the mouth, from my mentors in that firm really resonated with me and opened the door to the person I am today, which I speak with a lot of pride for the work I have done and I aspire to do and the knowledge that I aspire to share with all of you.

- Thank you so much Fernando.

And it's really interesting that you have really incredible international background.

You were born in Portugal and receive your education in Venezuela and then coming to United States and practice and then we have a lot of international students as well.

So what's your thought?

And then can you share a little bit about that, the whole process and then you are doing international project right now, that's your advantage, right?

- Yes.

Just at the beginning, I think that's certainly an advantage.

The fact that I cannot really box myself with a specific background or culture.

I think that created a person that is very open minded in terms of acquire knowledge and interacting with people from different parts of the world.

The process of what I came to be who I am forced by my father being somebody that had to move from country to country because of his work.

And I started school when I was living in Spain and moved to Venezuela, yes, I went to school in Caracas.

I graduated there and then I came to the US.

I went to the process of getting my degree accredited here and became a licensed architect in the US as well.

And of course after that as Ray said, I pursued my board certification at the American College of Healthcare Architects.

And something that we haven't mentioned today is that actually, I'm working this moment with a school in Spain to obtain my masters in healthcare architecture and processes.

So I continue to try to stay current with knowledge and really making sure that my message and the knowledge that I can acquire is relevant and probably for those like you that come from different parts of the world, to come here and learn from the best.

The access to the knowledge to the people that this platform here in Texas A&M offers to you.

I think is incredible.

It's so powerful.

And as I said, coming here and share this story with all of you for me, I do it with great joy and hopefully will continue to do that for the years to come.

- Yeah, thank you Fernando.

It's always great to have you here.

- Thank you.

- Thanks.

- Thanks (mumbles).

If nobody else has a question, I'd like to slip one in.

We just have a little bit of time.

Can you think of something that you saw in another country in healthcare that struck you as, hey, they've got it figured out and that's better than the way we do it.

Can you think of some of those things?

- I will just speaking for example about the patient room.

- Okay.

- I think I mentioned that the patient rooms we design in Lisbon are done in a complete different way.

They're single patient rooms, but they're organize differently.

And that comes from a conversation to the client that he challenge us and say, "Fernando, do you really think that "we are going to do the patient room that way?"

And I say, "What do you mean?

"Are you gonna seat people against the window?"

I cannot see you.

It's exactly what's happening here, I'm talking to the audience, but I have difficulty to really make your faces because of the light coming through.

Well, a patient that is in the bed that has some challenges in terms of looking to figure out surroundings, et cetera, is never a able to really communicate with people.

So what we did there, we switched the patient room and the family area is on the inside.

And for me that wasn't aha moment and probably I would have never got to that place if the client would not have challenged me.

- Great example.

And our time is almost up.

Any final words?

Certainly a thank you.

Let's thank Fernando for coming.

(audience applauding) And we'll look forward to seeing the rest of you online and those of you here in the studio next Friday.

Thanks so much for being here today.

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