- Good afternoon and welcome to the Architecture for Health Lecture series.

It's great to have you with us.

We got a terrific program today from Perkins Eastman Architects.

Joining us here in the studio is Carlos Moreno, Associate Principal and healthcare architect at Perkins Eastman in Austin, Texas.

Carlos did his training at Ball State, starting with a BS in environmental design, then a BArch, then an MArch.

Carlos has been very involved with the Center for Health Systems and Design, brings a a wealth of experience to our conversations.

Lots of different building types in healthcare, a lot of strength in that design type.

And currently working with Kirk Hamilton, building a new curriculum for us with an emphasis on research and in professional practice.

And we're excited about where that might go.

It's great to have Carlos with us in the studio today.

And joining us online is Dan Brown, a senior associate and healthcare planner with Perkins Eastman, Pittsburgh, Pennsylvania.

Dan, it's great to have you with us.

Dan did his training at the University of Kansas and I'm sure that was good.

I'm sure that was wonderful.

Not A&M, but it's great to have you, Dan.

Lots of years of experience in healthcare architecture.

Dan is board certified by the American College of Healthcare Architects and it is terrific to have you with us, Dan.

Dan's passion is mentorship in the profession and we certainly need more of that.

Carlos, Dan, great to have you with us today.

We welcome your remarks.

Carlos, - Thank you very, very much.

- Terrific.

- Thank you.

Thank you.

Well, hello everybody again.

My name is Carlos Moreno, as Ray just indicated, I'm an associate principal with Perkins Eastman in Austin.

I really do appreciate this opportunity and certainly the very kind words that Ray just made.

I wanna speak a little bit about Dan with respect to this presentation because as you can see on the title, Perkins Eastman Healthcare Planning in the post university world, there's something to be said about training of an architect.

There's a lot to be said about training of an architect going into healthcare.

And when we talk about this, I think Dan is a great personification of what all of this means.

And I wanna focus on that perspective by way of what you see on the screen right now, Human by Design.

And instead of reading all that you see by by paragraph on the screen, let me read a little bit of what it does say.

Almost near the near end of that: Our diverse teams partner with our clients globally to deliver next generation projects that are uniquely suited, uniquely suited to users who live, work, play, learn, age.

I'll stop right there.

I think that when you start listening to all that we're gonna talk about, all the things that you're gonna see on the screen, I'd like you to think about Human by Design.

It's not just a tagline, it's definitely what we believe at Perkins Eastman.

And it's definitely part of the application, if you will, of how we do our work at Perkins Eastman.

But let me go a little bit deeper.

Human by Design also addresses how we work with one another.

So it's a one-on-one relationship and the underscoring of that word relationship cannot be done enough in bold.

And so when you start listening to us, think about how you might also be involved in such a process.

So let's speak to the agenda.

Our agenda today is fourfold.

Okay?

What Dan and I have done is we've actually subdivided this presentation into two parts.

I'm gonna take the first two elements of this agenda, the 2023 Architecture for Health.

And I'm just gonna speak globally in terms of the things that we've been learning since January 27th, the beginning of the Architecture for Health series.

And then I'm gonna certainly speak about Perkins Eastman.

I think it's important that you hear who we are, what we do, where we do it, why we do it as well.

Because that's gonna serve as a foundation for the elements that Dan's gonna speak to.

Healthcare planning and experiences and possibly right next to all those things, you can take the word experience and tie that together with relationships as it further, again, underscores Human by Design.

Because as Dan and I speak, you'll be hearing a lot about architectural practice, which is amongst one of the learning objectives.

Also understanding the rules and features of healthcare planning, post-graduation, understanding the opportunities for direct application of post-graduate degree focused on healthcare and client management.

And I'm really excited about Dan speaking to this issue.

And then finally, understanding the realm of project management planning design in rapid response to natural disasters.

This is gonna be a lot of fun.

So as I said a little bit ago, I want to talk about Dan for a little bit.

Dan comes to the table at Perkins Eastman with 10 years of experience.

I come to the table at Perkins Eastman with roughly 30 years of experience.

That may sound like a long distance in duration factors from 10 years to 30.

When you're educating yourself within this paradigm of healthcare, healthcare design, things happen exponentially.

Things happen dynamically.

And so when Dan and I first met, we actually began working together on a 600-bed hospital reassessment, if you will, of an existing chassis located in Austin, Texas.

And through that initial experience, which is about six months ago now, and ongoing, I learned a lot about Dan.

I learned a lot about his experience.

Though 10 years, in that 10 years he has excelled dramatically.

In addition to that, the words I want you to hear is that he's not only a healthcare planner, but he's also an architect.

As you also heard from Ray, he's also certified with ACHA.

Beyond that, he's also a project manager, a designer, call him a renaissance man of sorts, if you will, within the architecture practice and field.

And I point those things out because it goes directly to what's on this first portion or this first bullet point, dispelling stereotypes.

Dan really blows this thing out of the water relative to the dispelling of the stereotypes.

Once upon a time when I began almost 30 years ago, we were doing toilet partitions and things like that.

Not to say that that's bad stuff 'cause it's certainly not and definitely has an application to everything that we do on an everyday basis.

But where Dan has been has really opened my eyes quite wide to the realms of possibilities that all the architects coming outta school will now be able to go to and into relative to, let's say in this case Perkins Eastman.

Academics research professional practice, the second bullet note, we talked a lot about these things from January 27th with Earl Swensson and Associates onto page down to Gresham Smith, and now of course Perkins Eastman.

Everything that we do, all of us that are on this list, it's all about academia, right?

It's all about continuing to learn and nonstop learning.

But beyond that, it's all about the application of that research into professional practice that helps us do what it is that we're doing that helps us inform our clients, inform ourselves, have that platform of synergy, if you will, amongst ourselves on any given platform, okay?

Whether it's in the office, whether it's hybrid like we're experiencing here right now with Dan and Pittsburgh, me here in College Station.

So therefore things are non-traditional, as we see it right now.

But that includes the paths, the paths that are being followed by you all in the audience, by you all listening and watching long distance via Zoom and the many who will be seeing this hopefully later.

Learning that the path of an architect in healthcare will take you in so many different ways.

Artificial intelligence is now really coming to the forefront with regard to redirecting how we can operate.

As a good example, I was just watching a news story just earlier this week as a matter of fact.

And they were talking about a cardiologist who now is stepping aside because AI, which is essentially a process and function via algorithms to actually identify by patterns, what needs to be seen, therefore then what needs to be done.

But apparently AI can now have that ability, call it even aptitude to spearhead something ahead of, let's say, when a cardiologist might actually see it, find it and know how to address it.

So things are really changing.

And so that means that when you all, when we, continue on in our professions, we are following nontraditional paths.

Challenges: work life balance, that's what the WLB stands for.

Work life balance, post pandemic technology.

We're gonna hear about these things off and on, off and on.

I mean if you take a look again at Zoom, look what it's changed in terms of meetings, in terms of being physically present in the office, which is always encouraged and I can speak a little bit to that later.

But also it goes down to responsiveness and establishing value.

One of the charges that each one of us that actually have spoken from Earl Swensson HDR, down to us again, Perkins Eastman, one of our charges is to help further dispel all those things that we once upon a time thought that architect graduates get involved in, but to also speak to the value, the value that we actually have in the graduate that's coming outta school.

And therefore then takes us next to the last; optimism and enthusiasm for the future.

There's a tremendous number of great things that we have to look forward to because of people like Dan and people who are still yet to graduate from their respective schools of architecture.

So with all that being said, let's reflect on a few things here relative to some hard data.

And through this, I'm gonna speak a little bit more to my own office in Austin, specifically the leadership and how we do it here in Texas.

So approximately over 25,000 new graduates are coming out each year here in the United States, 25,000 plus.

Okay?

3% projected growth in that number from 2021 to 2031, currently employed.

And again, you can see where I got this data and find it anywhere, but right now take a look at what the US Bureau of Labor Statistics shows.

Just over 152,000 architects currently are employed in the United States, 30,000, that's not of that 152.

There's an additional 30,000 plus architectural interns employed in the United States.

23.3% of all architectures are women, while 76.7% are men.

37.3 are all architecture interns that are women.

And the other 62.7 are men.

Let me stop here for a second.

I wanna talk Austin, Texas in relative to the Perkins Eastman leadership in Austin.

The managing principal of my office is Hillary Berks.

She's FAIA.

She has a historic and well-decorated past in her profession of being an architect from New York City now down to Austin, Texas.

And through that she has been able to join us in Austin and has taken leadership of our team in Austin.

It's roughly about 12 to 15 given on what day you might be looking at.

I mentioned Hillary because she is one of those leaders, women leaders within our firm of roughly 1,100 plus people that really has taken that to task, making sure that she is a leader amongst her peers, but also a leader of all of us who are following and seeing where else can we derive diversity, if you will, relative to men and women being in this profession.

Next to that, I'll also mention that we had just recently Emily Pearson Brown, who actually spearheads our effort of diversity, inclusion and equity within our corporation of Perkins Eastman.

And through these discussions, it all goes back to what we began with Human by Design.

And so it's been a phenomenal trek in taking a look at where our history has been and where we're going to be sure.

Moving on, Perkins Eastman, it's history: We were established roughly 40 plus years ago, 1981 in New York City, Bradford Perkins and Mary-Jean Eastman.

They were the co-spearhead leaders of this organization that we know as Perkins Eastman.

And again, going back to Human by Design in the efforts thereof: Vision founded on the idea that design can have a direct and positive impact on people's lives and the planet.

So I'm gonna speak to a few other people that are representative of our group.

So on this global reach slide that you're looking at, obviously you're looking at the fact that we have 24 offices worldwide, again, established in 1981, over 850 awards, 1,100 plus employees.

But take a look at specifically where we're at.

Let's take for instance Mumbai, India where we have a phenomenal leader by the name of Tania Phillips.

And Tania Phillips who just celebrated last year and she's the healthcare leader in the Mumbai Studio.

We call our offices studios.

And through her leadership, she actually was celebrated by a project that she did in India that was actually serving a group of women who were looking for midwife services.

And so this was actually through the Aastrika Clinic that she was actually instrumental in designing, planning and so on and therefore executing into reality.

And this is the only kind of facility of its kind that provides in-house, inpatient, midwife, midwifery services.

And so I bring her up and she's also an A&M grad and I think it can't be dismissed that what A&M has been churning out as well as the University of Kansas, certainly Ball State, Cornell, Texas Tech University, we've all been able to focus on these various traits of what's coming out of healthcare by way of needs and what our service to those needs in the population across this planet.

So our practice areas, here at Perkins Eastman, right here you're finding certainly combined back to back or side to side healthcare and senior living because they inform one another.

But take a look at the other areas of our portfolio, everything from transportation to mixed use and so on.

It goes to how we focus on the leadership, how we focus on the top tier components of the industry globally.

On this list right here, you're seeing a good cross section, if you will, of some of our key clients that we continue to this day working with and working for.

And I say that very, very strategically because we work with our clients.

Yes, we work for them indeed, but we partner with them and it's absolutely critical that that kind of relationship is born out of every opportunity that comes across our path.

Same thing here with regard to what we believe.

If you take a look at the publications here, you see here in 2021, Healthcare Design Magazine identified as as an Outstanding Organization, Fast Company Magazine in 2021, Most Innovative Design Solutions providers within the industry.

American Institute of Architects, of course, identifying as for Best Healing Spaces back in 2021.

But not just here, would you find the name of Perkins Eastman, but in many other publications where the application of our research, the application of things that we're doing on the ground, as we sometimes say, boots on the ground, helping our clients reach their clientele, reaching the populations that we're serving regionally.

So let's speak a little bit to that.

Perkins Eastman Healthcare.

We are leading healthcare consulting, design and planning firm that is, as I just mentioned, regionally focused, definitely rooted in our client's business success, focusing on strategic visioning, the infusion of technology, facility development, patient and family-centered care.

But the list goes on.

I think it really bears worth mentioning that when we're rooted with our clients, we're trying to understand their business.

And that's all part of architecture practice.

You must understand the business and for all of us, all of you who are graduating from your respective schools and certainly Texas A&M to stay on top of that.

The key individuals that are actually continuing to hone their abilities and research are the ones that are able to drive and help further pattern where the firm could be going relative to a certain modality, to a certain function or even subset of functions within a variety of healthcare issues that are gonna be coming up.

Our experience: from inpatient care to science and technology and many things in between.

I know y'all can see this slide, but I want to focus on, as an example, even my own upbringing in healthcare.

You might have heard me speak of this before in other situations where bone marrow transplant, which is a huge issue in many other locales as you see under this component, comprehensive cancer care, well, bone marrow transplant, the BMT was part of my opportunity to actually break outside of my own shell many, many years ago when I actually had my first bone marrow transplant project with the Children's Hospital in San Antonio.

Learning every aspect of what happens to a body that is immuno-compromised really opens your eyes to how valuable we are within the healthcare group.

Everything from doors, everything to air filtration, everything to bed position, everything from movement and circulation of one body through a vestibule into an environmentally protected space.

These are things that you typically don't think about from a common everyday standpoint, but when you actually get into the granular components of what is going on with not an adult patient but a child patient, it really changes your perspective on what's important in knowing how valuable and really how impactful you are as a healthcare architect.

And that was one of the most phenomenal experiences I ever had.

And I still remember that to this day.

Working with facilities management directors from A to Z in dealing with issues pertaining to aspergillosis, issues pertaining to construction.

What are you supposed to do prior to construction, during construction, post-construction.

What happens to the air that even gets emitted out of the space of construction?

These are areas, these are areas that you have an opportunity to, to get involved in.

So design informed by this experience, these areas of experience that I just got finished speaking to by that slide.

We have the opportunity to combine these things and to speak of how are they transformational?

How do they inspire, how are they adaptive?

But next to that, hospitality, where do we bring in the hospitality end to what we're looking at right now?

As a quick example, I'm working right now with a young lady by the name of Tanchen Nay.

And she was unfortunately not able to join us here today, but she's a young architect who also graduated from Texas A&M, and she's been vitally important in just helping display the breakdown of one of the hospitals that we're really just doing a refresh, okay?

And I say just a refresh, it's really much more in depth than that.

So when you start taking a look at projects, never take them as trite, never take them as possibly boring or there is nothing boring.

There is nothing small or too large within healthcare.

I've discovered in my own profession as I'm even sharing with Tanchen, that even some of the smallest projects I've ever worked on have actually turned out to be the most complex, sometimes because you're dealing with existing conditions just like Tanchen is dealing with and trying to understand the flow vertically and horizontally.

Similar to what Dan is working with me on right now on that other 600 bed facility that we're looking at.

So through all this, we now talk about convergence.

It's the middle portion of what you see on this slide, the convergence.

We're actually bringing together all the various facets of what we do extremely well at Perkins Eastman from the academic to the clinical to the hospitality.

And so there's great power in that.

There's great power in this convergence, what it can actually do for the end user, but also the staff person.

And Dan's gonna talk a little bit about that when he gets into his areas of discussion.

So what does that look like though?

So this is a good example right now that you're looking at of hospitality and flexibility coming together.

This is what would be considered the exploited waiting room to where now it's not just waiting but it's actually the multiplicity of other functions.

You can study, you can have business, you can have conferences, you can have consultation opportunities with your doctor, with your specialists.

Things that are actually now changing the definition of certain modalities, yes, but even some general functional space that we typically program into our buildings.

Bringing beautiful and mindfulness within the design, there's a lot to be said about the whole retail and commercial aspect and what that means to the passerby when you're looking at the storefront and so on.

What happens when you're bringing that into the healthcare theater?

What happens when you actually capture the eye for the wow space to further entice them?

We often talk about the first physical connection that you have with a building is the doorknob.

Think about that.

Your first physical interaction with the building is the doorknob or the door handle, 'cause we don't use knobs anymore, right?

Think about how detailed you can actually get into the facets of design.

And then of course, peace and tranquility.

All of us who have dealt with issues of healthcare, whether it be an emergency, whether it be just a standard routine checkup, we're still nervous.

Even us healthcare architects, some of us like the sight of blood, like myself, others don't.

And I think that peace and tranquility are very much a part of what we do and how we can bring all the various sets of talent within your organizations to actually focus on these things.

How to bring peace, how to bring comfort, how to bring that notion of everything's going to be okay.

And probably the best part about it is that this is representative of the quality of care that you're about to receive.

So with that serves as a good segue to Dan and Dan's gonna speak about a number of his personal experiences as a young architect graduating from the University of Kansas, what it means to have gone into projects within his first six months, third year, fifth year, now 10 years at Perkins Eastman, and how you all can reflect on this and where do you fit into this menu, if you will.

Because the menu again, is quite substantial of the many things you can do.

So Dan, I'm handing it over to you, buddy.

- All right, thank you Carlos.

Hopefully everyone can hear me okay.

Like Carlos said, when he approached me about this presentation, he had kind of asked me to take a look back on my I'll say very young 10-year career and reflect to say what is healthcare planning and what are the facets and subspecialties that one as a recent graduate might be able to get into?

So that's what I really tried to focus on and reflect on on this presentation as well as share my own experiences with you.

As a number of you are getting ready to graduate and kind of show a path of what one person could take.

Of course everybody's is different, but having that understanding of that these things are real and this is a path that you can potentially take.

So we can jump to the next slide, please.

I will say I unfortunately cannot see the screen.

Thank you.

So when you start to look at areas of healthcare planning as I really started to, to shape this presentation there's almost three major buckets, if you will, of what I kind of define as healthcare planning.

There's the strategic side all the way down to what I'll call the equipment planning side.

And there's of course anywhere and everywhere in between.

So at the strategic side, that's when you really are working in future long-term vision and you have a client approach you and they say, "What is our campus going to look like in the next 5, 10, 15 years?

And, and how do we get there?"

So it is a giant, think of a hospital campus as a giant puzzle, if you will, of how do we get there and what are their goals and what do they want to achieve?

So it's moving the bits and pieces and parts around and sometimes it's new buildings or sometimes it's, unfortunately we don't have a lot of capital, so how do we best utilize what we have to provide the best care possible?

And I refer to that at the bottom there as you see, you're thinking at the 30,000 foot level of detail, it's very high level, big picture thinking.

And then of course, as hopefully these master plans start to come to life, you get into the planning and programming and space planning of these, as you do a building.

And one could even take the approach of as Carlos showed earlier of our expertise in various areas.

Sometimes people are specific planners and space programmers for particular departments.

Sometimes it's purely outpatient.

And then sometimes that can even go into your expertise is really, infusion and cancer care or radiology and surgery.

You can start to take those paths of how do you lay out and configure these departments with the relationship of rooms to one another to make them successful?

And you continue to work that time over time over time to become that particular expert in those areas or you can continue to do it at a high level of you're given a hundred thousand square foot MOB and 15 departments and you can figure the whole program like you see in the building in the middle, which I'll speak to a little bit later.

So now we're bringing the plane down a little bit from I'll say 30,000 feet down to I'll say 5,000 and then continuing to go down.

You can even get into the equipment aspect of it.

So once all the rooms are configured and you have doors and everything else, how does every single piece of equipment and furniture configure in that room?

Because in healthcare especially, we know and we understand that all of those pieces of equipment have a relationship to one another, especially when time is of the essence.

And, and by that I mean in a trauma room in an ED where a doctor is trying to save a patient's life, making sure that equipment is in the price, in the exact precise location where it needs to be, is crucial to the success of those spaces.

So, sometimes we get into the, that's what I'll call the 16th inch level of detail.

And sometimes planners like myself, we go from 16th inch level of thinking in the morning to 30,000 square feet in the afternoon and everything in between.

And that's what I have found most fascinating in my career is that level of thought.

But with this I also want to say who are we working with in these different areas?

'Cause I think that's also vital to understanding potentially where one might want to be.

So as I alluded to at the strategic level, those are more corporate leadership discussions.

Those are, as we refer to them, the C-suite, the CEOs, the CFOs, the CNOs, really having those high level discussions of how do we get your medical campus or building or entire healthcare service line where you want to be in the next 5, 10, 15 years.

Like I said, of course we also bring in departmental leadership at times.

Sometimes they're very focused discussions.

This is also where we bring in to help inform that process.

We will do a lot of work with data and analytics.

Sometimes that is hired out of house, sometimes we do that in-house to help set expectations of, yes we need to grow, but the question then becomes how big do we need to grow?

How many beds do we think we need in the next five, 10 years?

How many operating rooms do we think we need?

Those are all based on numbers and facts of past history and performance of the institution based on market trends in the area.

That's how we get to these discussions.

And then of course, outside you're starting to work with planning commissions and zoning boards and then as like I said, as we begin to take that step down, now we're in the planning and space programming of actually defining and shaping what those spaces look like.

And a lot of times, who are we working with?

You work with the people that are in the spaces every day, your doctors and your nurses and your maintenance staff.

Of course by this point you have to bring in your various consultants of MEP and structural and sometime equipment and acoustics and everybody else.

And with that also, this is where you start to get the realization of a project of maybe the design isn't a as great as we wanted it to be.

Because you have not only within healthcare we have IBC and NFPA, but we also deal with CMS and, and JCO and FGI and a whole other smattering of regulatory agencies that help define and inform our projects.

And like I said, who are we designing these spaces for?

Of course, to the far left there, patient and family of of course is probably, I would almost say number one.

We have patients and families that are entering our buildings most times when they're at their most scared and most vulnerable.

So how can our design impact and help mitigate some of that fear as they are coming in for a particular procedure?

And I mean also dealing with an age gap of anyone from a newborn all the way to someone approaching end of life and everyone in between.

So how do you curtail and cater all of those varying demographics into a successful building to help lower that fear that someone might have?

Again, going back to a caregiver and physician, I said sometimes we go down to the 16th inch level of detail, a neurosurgeon doing a case and in an OR has to deal with precision down to the millimeter.

So how do our spaces help allow them to do their job at their maximum capacity as well as various specialists of bringing certain equipment in for a certain procedure in an OR that might not be there every day.

How do we basically have the kit of parts to make it interchangeable or readily adaptable?

Then also administration is looking at the success of the building from a patient experience perspective can help drive their HCAP scores.

And HCAP as you know is a basically a questionnaire that is filled out by patients based on their experience and that can help inform reimbursement rates for a hospital.

So the better the design, the happier the patient, the more money a hospital could essentially get.

And then also thinking all the way down to the maintenance staff of where are their bits and pieces and parts of, if they need to access something, making sure that a room might not have to be taken offline for an extended period of time.

'Cause we know that hospitals are a 24 hour day, seven day a week, 365 day operation.

They never close.

It's one of the rare building types that never closes.

So.

Making sure that we have everything in place.

And then also, I just wanted to speak to going back as a planner, as I kind of reflect on my 10-year career, you kind of see the three buckets or three pieces of the pie there of planning, design and construction.

And one of the things that I wanted to speak to is they all interrelate to one another.

A lot of times planners, yes, we are involved in the upfront process and not always involved in the construction of the building, but I would speak to newer or entry level staff that are entering the workforce.

Understand all three pieces of the pie because understanding construction will make you a better planner in the upfront.

And understanding planning will help better inform the construction process.

So if there's one thing that you take away from this, that's kind of what I wanted to speak to as a role of a healthcare planner, if you have the opportunity to do that.

And then with that I wanted to share some of my experiences and I call them experiences and not projects because as Carlos said, each one innately will impact your life in another way.

And what I wanted to start with, this is actually my first project out of my graduation from the University of Kansas.

While this is the end result of this project, I had absolutely zero involvement in what you see on the screen.

My involvement was actually on the next slide, we wanna advance, I actually drove through this on my way back from graduation from the University of Kansas.

Joplin, Missouri is located in, I'll say the southwest corner of the state.

As I was driving back, 'cause I lived in St. Louis at the time, this is what I drove through the remnants of this level five tornado that essentially leveled the existing hospital for Joplin, Missouri.

Took everything out of commission, as you can see, coincidentally the hospital was actually planning on building a new hospital closer to a major highway.

Anyway, this just accelerated it.

So.

I graduated on a Saturday that following Tuesday I was basically what I'll call it ground zero helping for the first six months of my life.

And by help I mean anything and everything from helping get their field hospital set up, which was about a week after the tornado.

So they were at least able to provide minimal ICU services to those that couldn't travel.

They unloaded a number of other patients that could go to other facilities as well as planning for the modular hospital to the right, which you see there, that was completed roughly eight months after the tornado.

And that was delivered, it's all modular, it was delivered via rail out of California.

It was just basically 250 rail cars that came in and were picked and set in a particular way.

And that was their hospital until on the first slide that you saw there, that was completed about four years after the tornado.

And then on top of that, working with their leadership, they would approach us and say we leased X number of square feet in a strip mall nearby, what clinic do we feel is most appropriate?

So helping them get all of their ambulatory services back up and running as quickly as possible as well as working with the inpatient hospital.

And then again, that was tornado.

This was a project about five years into my career that I worked with Mount Sinai down in Miami.

This is the only hospital located on Miami Beach, but how do they react to hurricane?

So this building was built and constructed to withstand a level five hurricane and also 100-year flood.

So it's set up on a pedestal, number of redundancies, glazing to take the impact of high winds.

But with this as well from a planning perspective is when you bring new towers and new things online, sometimes the ancillary space is forgot about.

So my primary focus on this project while dealing with Miami-Dade County and making sure that we met the needs if, when a hurricane would come through Miami again, it was also making sure that those ancillary support spaces could support the new tower and the new ORs and the new emergency department.

So, moving bits and pieces around, like I said at the strategic level to provide the space for your central sterile and your materials management and things like that.

And then, we talked terms of scale, that project was 154 beds.

This, I will not try to pronounce the name, I don't speak French, but we know it as the CHUM at the time.

I believe it still is.

This is the largest hospital in North America, just over 3 million square feet located in Montreal, Canada, 775 beds, 40 ORs.

But as Carlos spoke to earlier, the level of detail and things that we can get into in our path is really interesting.

And while I come off of a healthcare planning project, like you saw in Miami Beach, here, I was tasked with doors as Carlos even alluded to earlier.

Helping the team understand the door hardware and coordination of getting from point A to point B in the building and understanding complexities associated with healthcare from a security perspective, smoke compartment perspective, as Carlos said in patients that are immunocompromised, how interlocking and everything works.

So I was dealing with all of those as well as I'll say day-to-day management of just door hardware in general, to the tune of over 10,000 doors.

I was a member of a team helping manage it that scope.

And now here we are today at 10 years.

What are we doing at Perkins Eastman as a healthcare planner?

Again, back down in Miami this time working for the University of Miami on a master plan.

Perkins Eastman had done a plan a few years prior to me joining and then they asked us to come back and take a look at a refresh.

A lot of things were kind of changing in the market.

So what you see there on the left is again where we say, "What do we wanna look like in the next 5, 10, 15 years?"

So that is how do we expand the bed tower capacity if it's required?

The photo in the upper right hand corner, one of their biggest fears is at the time they were the largest NCI designated cancer center in the area and now a lot of other big players in the market are starting to enter South Florida.

And they wanted to say, how do we maintain our market share in the area?

So we were looking at a brand new cancer center and then along with that they actually housed the number one ophthalmology clinic in the country and they were operating in a 1970s building and they said that building does not represent our standing as the number one ophthalmology cancer in this country.

So developing new branding and building for them to reflect that.

Another one here is Duly Health and Care, which is outside of Chicago.

We were planning three brand new medical office buildings simultaneously for them at a hundred thousand square feet apiece.

This one here is was one actually of, this is big box retail.

So they bought an existing building and said, "How do we convert big box retail into a healthcare space?"

Now to give a sense of scale on this one is roughly in both directions.

You're at 300 feet or a hundred yards away.

If we could go back to the previous slide, I apologize.

And how do we get patients from the parking lot into the building which is there on the bottom, all the way into that upper right hand corner without it feeling like walking the distance of a football field?

Duly was also very big on technology, which, and AI, which Carlos alluded to earlier.

I mean one of the things that they were asking us to really push on and try to understand, I'll give the example, I'm sure most of us have been to a restaurant where if there's a wait, they give you the buzzer.

Well that's even now become a thing of the past.

You give a name and cell phone number and you're getting a text message when your table's ready.

They were starting to take the same approach at that building.

Now you can sit in various areas of the building and then be escorted when your exam room is ready for you.

This was one of the new builds that we did for them, a hundred thousand square feet on a much more compact site because we were able to go vertical with it.

And again, with this one, what are complexities of how do we align services of care in the various floors of the building with an attached parking garage?

So on the ground floor, of course we had our radiology and everybody else, but then we took the advantage of, okay, wherever the roof deck of the parking garage aligns with the top floor of the building, we'll put other, I'll say more difficult non-ambulatory services.

So that's where we located orthopedics, PT, OT and others, knowing that a lot of times they are walking with some sort of assistance.

So basically treating the third floor like the ground floor of a building without having to take stairs and elevators.

And then also how does technology integrate into that?

And then lastly, I wanted to represent, of course, as Carlos alluded to earlier.

We have offices all over the world.

I've had the opportunity to work on a project for a confidential client in Hong Kong of reworking a brand new bed tower expansion.

And here is understanding that in China that it's still normal practice to operate in a six-bed open ward.

But one of the things that they had asked about this was coming still and I'll say in the heart of the pandemic of how do we convert a six-bed open ward to an eight-bed ward when the next pandemic happens, if the next pandemic happens?

So spending a lot of time understanding head wall placements and conversion of medical gases and getting things moving and do we still meet the clearances required going, by adding two additional beds into these open wards was really kind of the crux of the study as well as the equipment and location and placement of everything else.

So with that, Carlos, I'll go ahead and let you close us out.

- Thank you very much.

Thank you very much.

And if y'all can hear me, I just appreciate this time that we've had.

I know that we're close to going over, but I really do appreciate your attention.

I think the critical thing that I'd like you to remember is just as Dan got finished eluding and kind of going in great detail about is that the world is pretty much your oyster.

You can make up this education that you've collected, that you've established in your mind as to really how you want to apply that, go for it and don't stop and be tenacious about it as well.

Thank you very much.

(crowd applauds) - Thank you Carlos.

Thank you Dan.

Terrific message.

Is there a question here in the audience, someone like to ask of Carlos and or Dan?

So Dan, I'll ask a question of you.

You've got a group here in the studio that's not too far from being in the game, as it were.

What would you offer to them as something they might wanna be sure they get some exposure to here before they leave?

What are the things that you studied that were of the greatest value as you transitioned to professional practice?

- I mean, I will say for me, unfortunately, I'm gonna speak in in Jayhawk world here for, for just a moment.

Having the opportunity to do a internship that specialized in healthcare was crucial to me as well.

That was actually coming out of that first project I showed in Joplin.

I actually had a job lined up with who I interned with prior to graduation, but that's where I also, they specialized in healthcare planning.

They didn't take projects much past design development.

So that's where I really started to get my feet wet in understanding what planning is and what value it brings to a healthcare client or institution.

- Is there a another pressing question here in the audience that someone would like to, anything online, (indistinct)?

Any question?

Dan, we actually know the Kansas program pretty well and have an awful lot of respect for it.

It's just fun to to joke with the others of us who are in this game.

- Frank was my mentor.

- Frank?

Oh, of course.

(laughs) And you can't find one any better.

Good for you.

Any others?

Well then let me say thanks one more time.

Carlos, Dan, it was terrific having you with us here in the studio today.

Thanks so much for bringing your presentation.

- Thank you.

(audience applauds) (upbeat music)