- Welcome to the Architecture for Health Friday lecture series.

It's great to have you with us.

We're starting a new season in fall of 2023, so glad you could join us.

We are in for a special treat today.

Our speaker is Autumn Leverage.

Autumn spent 22 years in US military service, retiring as a lieutenant colonel, and I'll just pause right there and say thank you.

I just appreciate our veterans so very, very much for their service.

Thank you for that, y'all.

(audience applauding) Thank you for that very, very much.

By way of educational background, Autumn graduated from A&M.

She's homegrown, 1998, a BS in biomedical engineering, 2013 an MS in civil engineering, both of those from Texas A&M.

And in 2015, she was in residence for a Master's of Military Arts and Science at the US Army Command General Staff College in Fort Leavenworth, Kansas.

She had a variety of positions during her 22 years of military service in several times in major positions of responsibility with the US Army Health Facility Planning Agency, with which I was familiar during my career.

Then she was the onsite owners rep for the delivery of the Bagram Hospital in Bagram, Afghanistan.

She finished her years of service in the military as the technical advisor to US European Command and NATO from 2015 to '18.

All in all, a particularly distinguished career, not just long with 22 solid years, but distinguished in what she accomplished.

Notably, to cap off that activity, and this is important, y'all get this.

2022, Autumn was awarded the US Army Legion of Merit Medal.

Now I'm just gonna read you very briefly the descriptor of what that means when you're given this award just so you can get a sense of the prestige of it.

You ready?

Exceptionally meritorious conduct in the performance of outstanding services and achievements.

Wouldn't you love to have somebody say that about your career?

That's a remarkable tribute to have earned in military service.

Autumn, thank you again for that service.

Quite a distinguished career, and welcome to the series.

We're looking forward to hearing from you.

- Thank you very much Ray.

- [Ray] Help me welcome Autumn.

(audience applauding) - Howdy.

- [Students] Howdy.

- It's good to be here.

Good to be back on campus and with all the students.

And then for those virtually as well, happy to have you with us today.

You know, Ray mentioned quite a lot of things, but really it's about the people, right?

You know, you don't operate in a vacuum, you don't do things alone.

It's about building the team.

And that kind of is gonna link into what we're gonna chat a little bit about today in project planning.

The Center for Health System Design asked me to put together some outcomes.

And so I pulled these from what I am teaching in my class in construction cost estimating.

To make that relevant to really any audience that's gonna be dealing with project planning and delivery of a construction project even through healthcare and design.

So the first, and I'm kind of gonna present these in sort of three contexts, and the first is know thyself, right?

It's important to know what your strengths are, what your weaknesses are, areas that you want to work on and to improve.

And for those students who are here, I spoke with some of you as we stood outside and you know, some are working on their masters, some are working on their PhD.

Some have come from engineering and said, "Hey, you know, I've really seen that "I'll have an opportunity to be able to affect "the outcome of a building "if I can get more involved earlier in the planning process, "earlier in the design process".

So, does anybody know what this picture, this graphic is in the background?

It's the students.

It's the students at Texas A&M, and they are arm in arm as they, as we sing our song.

And I think that truly represents when planning for project delivery, it is working together.

It is building those relationships.

It is listening and understanding to a diverse group.

The more the diversity that you have on your project, I would assert the better your project planning and delivery will be.

So when you think about, okay, well, how do I know myself?

There are a whole lot of options.

Is anybody out there taking any personality test, Myers-Briggs?

Okay, some others.

And you can look at, hey, how do I manage relationships?

Am I an extrovert where I really get energy when I'm around a great group of people, a large group of people.

You know do I go home and that powers me for the next week?

Are you more on the introvert side where it's not that you can't be in front of people?

It's not that you can't lead people, but perhaps that draws some of your energy.

Understanding and knowing yourself and project planning helps you to be able to best serve and deliver as you're working through that process.

Similarly, when you're looking at how you perceive information, how you process information, are there intuitive and creative ways that you look through this?

Are you more of, let's see what the book says.

Let's practically look at what the practical applications and think about some of those differences on how practicalities are very important, but in the planning process, when we're looking at options and thinking outside of the box, it's important that we train ourselves on creativity to help come up with alternative potential options, courses of action, solutions, designs that we may not have thought about in the past.

Again, that kind of leads into decision making.

Do we really have a strong feeling and belief?

Our stakeholders that we work with?

Again, working with a diverse group, as we are designing healthcare facilities across the globe, there are all kinds of different cultures.

And so being able to help promote decision making while understanding what the culture of beliefs and feeling are for a different group of stakeholders, versus, again, hey, let me look at what does the architectural AIA digest number say?

You know, what does the American Concrete Institute technical specifications say?

You have to balance that in the decision making.

And similarly, organizationally balancing that flexibility versus structured.

I've worked with my class this week.

We talked about work breakdown structures when we're looking at a project, and I asked, well, how many different kinds of organizations might be integrated into the work activities of a work breakdown structure?

And as they started to think about all the stakeholders, you could really see how that hierarchal diagram can get very large, very quickly.

So being able to manage that and being able to have flexibility with you've got your design folks, you have your owners, you have your engineers, you have the news media.

Stakeholders that you may not even think about.

And being able to manage that flexibility and shift resources in your project planning is a huge key.

So if you wanna take a look at your self-assessment, I've put in here a web link.

This is a free test.

I have my students do this, 16 personalities, and you are able to enter this, you are able to answer some questions.

As I was talking with some of the students, and we were talking about previous personality tests, I said, well, I remember a personality test I took, and as I answered all the questions, I thought to myself, the questions are wrong.

So that being said, that when you run through a test like this, you don't necessarily have to think, hey, I am boxed into this group, right?

This is a self-assessment.

This is help you to gauge where you are at, again, your strengths and weaknesses, areas that you might wanna improve.

And so the questions may not always be the same, right?

As we go through life, as we get different experiences, our perspectives change and our personality, we can manage on where we wanna rely on some of these skills.

So again, as we think about objectives and project planning, you know, awareness, looking at the awareness of our process, looking at the tools that we're using.

How are we going... What are the tools that you're taking in your classes that are gonna help you to be a better practitioner?

How are we looking across the aisle in multi-disciplines who walks over to a different college or a different school on campus and says, hey, what are y'all doing?

What are the tools that you're using?

And how can you think about some of those best practices and tools to what you might be able to use in your designs, in your project plans?

Skill development, certainly oral communication, written communication, cooperation, working remotely, working across the globe.

We have the illustrious George Mann in the audience here, and I'll never forget when he would talk about going up into studio on a Saturday night or a Sunday night at 11:00 PM, why?

Because it was already Monday morning on the other side of the world.

And so to support those stakeholders, you know, how are you available?

How are you managing that communication?

One of the topics, and I'm sure y'all have heard it in your classes, and I kind of hear it in every organization that I go through, and every meeting that I sit in is about generative AI.

I just had a panel last week for my class, and we had a host of academia and industry all come together and talk to the students about estimating, about decision making.

And one of the gentleman that does a lot of creativity research, he said, you know, if we're not practicing writing, then we're not gonna know how to review through what a generative AI gives us.

We're not gonna know if it's any good if we don't practice our writing.

So I encourage you to write every day, whether that's in a journal by hand note, whether that's on your tech, you know, electronic device.

But use your own thoughts and use these to reflect.

Because again, as you grow and you progress through your career, it's gonna change.

And those reflections as a student today and as you become a practitioner, that's gonna be some really great insights on your development.

And as you go into industry and into the field on how you want to lead and train your team.

So very important to kind of document that.

And then as you see tools that are available such as generative AI, use those tools, but use them appropriately, use them safely, use them effectively.

And again, objectives in project planning too, learning, teamwork, inclusion, these are very important.

What happens when we exclude a group?

Anyone from the audience?

What are some of the effects that you might anticipate?

- [Student] Resentment.

- Okay, resentment that's a good one.

Missed opportunities.

Missed opportunities.

All right.

And then some of the...

So from the objectives in project planning, some of the outcomes, and if anybody's ever taken any kind of project management lectures or anything, you may hear about key performance indicators, KPIs.

And so the three kind of KPIs that are big in construction and project planning are time, cost and quality.

And so your time is related to your schedule that you're planning for this project, your cost, the budget that you have approved to spend, and then the quality, the scope that you are assigned to do in your design and in your project execution.

So these three key performance indicators, do you think that they operate independently in a vacuum?

- [Student] No.

- They're related, they're balanced.

When you pull more, when you require more time to plan and execute and design a project, it's probably gonna cost you more money.

Similarly, if you want a very high quality scope, it may cost you more, at least in the beginning term, right?

In the near term, some investment costs.

And I know there's a few here in the studio audience that are interested in academia and going into research.

And so one of the important things as we try to bring to stakeholders, try to bring to owners and try to bring to clients, hey, we do need a little bit more on our initial investment.

But having that research and data behind to show a return on investment, to show how long it may take to recapitalize some of those investment costs, you can clearly demonstrate that the design is the right thing to do, but really, especially working, if you're gonna be working with perhaps in private sector, there may be more funding available for some niceties that when you're working in public sector with the local or federal governments, you really, really need to show how it's gonna be savings for them in the long run.

Alright.

Know thy project.

Does anybody know this graphic in the background?

Okay, this is actually in Hawaii.

This is the Tripler Army Medical Center.

It was actually the original structure built in 1907.

Done some modifications through 1920, or 1920 it was named after the American Civil War, Bret Brigadier General Charles Stewart Tripler, World War II this facility expanded from 450 beds to 1000 beds.

And I'm sure in design for healthcare facilities, you'll have looked at that concept on how do we surge, how do we surge our healthcare facilities?

And I spoke with a couple of the students who I believe won a first place on their research project on talking about surging facilities in support of the recent pandemic.

So surge capacity is something that hospitals definitely keep in their mind, healthcare facilities.

And I think the project that the students were working on was for non-traditional facilities.

So the comment I made to them is, yes.

For example, the Javits Center, which I sent my soldiers to, to support that mission.

In between 1942 and 1948, the new Tripler facility was established.

They demoed the original, I think they were like seven wooden structures by 1959.

Knowing by project, knowing the culture of where you're constructing those original seven structures, I think were wooden structures.

And so as things change, you change your exterior, you change your... You've studied about, who's taken the foundations course, foundations in healthcare design?

Okay, great course, you will love that one to hear about through the centuries, how the designs have changed based upon the needs, based upon project needs, based upon cultural needs.

So I had my students do a first day quiz, tell me the definition of the project.

And so I like to put these kinds of things in a word art.

And you can see it's a building, it's being constructed.

You have to renovate it at some point.

You have needs, you've got to have a plan, you've got tasks you've got to accomplish.

You've gotta install equipment, you've have infrastructure needs to support your design, to support your project.

So all kinds of great responses.

The American Association of Cost Engineering defines a project here as a temporary endeavor, right?

You're looking at specific objectives, you operating within a time and a budget limitations.

And you've got a specified definition, you've got a scope.

And when you look, you are looking at these objectives and you're looking at the funding, and you're looking at the resources because you are gonna be doing this project, you're designing it, you're planning it to operate effectively in the built environment.

Who was around last week when we had that heat dome?

Yeah, it was pretty rough.

That was pretty rough for us.

But can you imagine on the building on the hospital, the stresses on, I think I had a student that was mentioning, they had done their undergraduate looking at HVAC design.

Can you imagine the stresses on the air conditioning?

You know, what's the capacity?

The energy generation.

How are these extreme factors planned for in your project planning process as the built environment changes?

When we think about healthcare construction, I added a little bit more.

So not only do we have the objectives or our funding requirements, our resources and time that we're considered with, we're thinking about, where is this built environment that we're trying to plan this project for, plan and design this project for?

But we have a goal, right?

Is that this is not just a warehouse, it's not just a stadium, it's not just a highway.

But we're looking at how can we best manage injury or illness, and how can we best promote health?

So we have that social mission in the planning and design of healthcare facilities that has much higher complexity in the project planning.

I didn't put it in this slide deck, but you can take a note and you can look up the Cynefin's framework, or you can send me an email and I'll share an article with you.

I'm not gonna pronounce or spell it right, C-Y-N-E-F-I-N.

But it talks about the looking at problem sets.

And again, this is in the context of decision making, going from the simple all the way through the complex and chaotic all the way to disorder.

And I would assert that planning and design for healthcare facilities, that really gets you to the top of that complexity level.

You have a lot going on and the timeframe from when you begin the planning and design, when you select your medical equipment and when it actually gets placed into operation and in treatment with the patient.

Think about the time lag of technology, right?

What does Moore's Law tell us about every two, I believe every 18 months to two years, there's like an exponential increase in changes in technology.

So how do we manage all of this in our project planning when we're trying to really look at that ends of best managing injury or illness and promoting health.

And then finally, know thy deeds.

And this is about managing expectations.

And this is not a healthcare facility.

Does anybody know what this graphic is?

(student speaking faintly) It's a dam.

Anybody know which dam this might be?

It's the Hoover Dam.

It's the Hoover Dam, and kind of just, I put in for a little symbolism on, managing expectations can be very challenging in project planning.

And if you don't have the right foundation, you can very easily get holes in the dam, cracks in the dam, things that can really derail your project.

So it's very important to have a good foundation.

And then I have the beavers, a little icon and just a plug, I am a liaison to the Beavers Association, which is a heavy civil organization that promotes the civil industry.

So talked about management, right?

We've gotta manage that foundation, manage these expectations.

Again, management science and the American Association of Cost Engineers has this definition for management.

Applying methods, processes, procedures for how you're gonna manage your decision making in your project planning.

Because you will have to make decisions, or you will have to, if the decision level is above your authority, you will have to prepare the data and prepare the evidence for that decision maker.

And you wanna best direct and control your project.

So as we think about decision making, we've talked a lot about how that's integrated in with people.

We look at how do we plan, how do we organize, how do we direct and how do we control?

I encourage you if y'all are interested in more of the controls, there is an entire project controls course that you can sign up for and take that looks at how are we looking into the greater and greater detail of managing this project planning.

Again I'll make a comment about generative AI.

I think that this is an excellent way in project controls and project planning on how generative AI can really inform the decision making by managing all of the data sets that come in, and then to take a look at what are the potential options, options analysis, because of the neural networked background behind generative AI.

So if you're looking for a thesis or a master's topic on healthcare design and how can generative AI and project controls best meet the needs of healthcare design and planning and execution of a healthcare project.

We all want this, right?

We want the project where... What do you see?

What do you see in this?

Let me get a couple of comments.

(student speaking faintly) Okay.

What else?

What do you think about, oh, go ahead.

(student speaking faintly) Right.

Flexibility.

Here you've got places for your heavy equipment.

Your crane has plenty of room to move around.

There's a very nice entry for everyone to come in and sign in and get any kind of safety training to maybe have some air conditioning in the work trailers to learn about, okay, what's going on on this project site, to be able to safely maneuver around.

It looks like you've kind of got some nice scenic hills in the background.

You've got lots of green trees.

This is the kind of green site that everybody wants, right?

Do you think that's the reality?

Oftentimes we're asked to do this in our project planning.

So what are some of the considerations that you might think when you see this?

What might jump out?

(student speaking faintly) Right.

So it's not necessarily just about the factors inside the construction site, but you see this little barrier on the left hand side.

And you know, you've gotta worry about people and cars who are passing by.

Look at the people who live around in the buildings around here, what are the noise controls?

You know, what is the project schedule?

What happens if you've got some project delays and your general contractors trying to get back on track and needs to bring in some extra crews and work at 11 o'clock at night, or through 2:00 AM?

The city's probably not gonna approve that, permitting, especially when you've got a brownfield site here where you're trying to make the best of what you have.

Unforeseen site conditions under what you have underground.

You know, in our plan, in our design, did we even consider what may be underground?

How are we gonna tie into the infrastructure for what we see here?

So managing expectations as you work through your planning and design process, work with a group of people to help again, use that creative thought to think outside of the box for what might happen.

What are the what ifs for our project?

Another cost estimating definition for project management.

And it talks about responsibilities and authorities.

Ray has these slides and he is welcome to share them with the class, that's perfectly fine.

So that way you don't have to worry about copying this whole definition down.

But really think about management.

Think about what all that entails.

Think about the authorities that you have.

Think about the authorities that you don't have.

You may, in some of your classes or some of your projects, you may be aware of a tool called a RACI diagram.

Has anybody ever heard of that?

Just a very simple table spreadsheet of who's responsible, who's accountable, who needs to be consulted and who needs to be informed.

And that can really help you in your project planning as you add more and more stakeholders onto your list to keep that tally.

You know, that way you know who to go to, you know who of the stakeholders that you know, they may not have any authority whatsoever, but goodness gracious, they sure need to be informed.

Because if it's not, it could cause a pretty significant challenge for your project.

Roles of a project manager?

Strategist, right?

You know, you may get the scope of the project, you may be working on the design of the project, but there's more than one way to design what outcomes you're trying to achieve, right?

And so how do you think about this strategy?

How do you take that scope of what the owner's asking for in your design and your plan?

And how do you relate that to the larger outcomes?

Remember when I said the ends for healthcare design and planning project is, hey, we wanna best manage injury or illness and best promote health.

You know you can look at that as, hey, that's really where I wanna get to.

So what are your intermediate, and I'll call them medical objectives, IMOs or medical design objectives that you can use to try to get from, this is our scope that we're planning and designing for, all the way to what your final in-state is.

That you wanna have something in the built environment that is promoting health and best managing injury or illness.

An onsite project manager, when you're looking at onsite construction, they are kind of the director of operations.

Everybody that's coming on site you know, going through the project manager.

They represent the projects, you're gonna have different kinds of project managers, and you're gonna have the project manager who does your furniture, fixtures and equipment.

You know, you're gonna have their project manager for your IT, you're gonna have all of these different project managers in this design and in your plan that you need to bring together and help to manage.

I would assert one of your biggest challenges as a project manager is where those interfaces come together, right?

Why is that?

Why do you think so?

- [Student] Schedules.

- Okay, schedules, what about perspectives?

Did the two or did the multiple interfaces always have the same perspective?

Does the biomedical equipment planner and the architectural designer always think about things from the same way, right?

So when they come together and have those interfaces, that's where you've gotta work to kind of manage that synchronization, you know, getting everybody to the same basic level of understanding.

And sometimes there may be some disagreements, right?

So managing those disagreements, helping to manage change.

And really the overall project manager is really that holder of the global picture.

Because they're working with all of these stakeholders and entities, so they get that exceptional information from each of these organizations and then they bring it together.

And other duties as assigned, right?

There's always something else that you need to consider.

And then just again, kind of looking for those desired abilities.

And I've chatted about that through the discussion today.

But this really kind of just shows you from each of these functions how you can consider things such as technical competency.

Do you need everybody on your project planning team to be a specialist?

Probably not.

You are gonna need some specialists and those are gonna be very important, but you've gotta judiciously manage that.

End to end.

Does anybody know what end-to-end means?

That's, again, looking from your very technical, tactical level all the way up to that biggest strategic picture.

End to end.

And then working this again together.

And I think the biggest thing is about working together as a team.

You are stronger together when you can bring people and promote positively.

You are gonna work with organizations and there is a whole science behind litigation, and you will work with stakeholders that are checking every single thing that you do to look for an option for litigation.

I tell my students, I say, "Hey, we're Texas Aggies.

"Be better than that".

You know if you see something that's wrong with design, catch it early on, bring it to the owner, have the ethical and moral high ground to do the right thing.

Your company may lose a few dollars in some potential litigation that they could make money on, but I would assert that in the long run your company's gonna be better off.

So do the right thing.

Maintain the agility and the flexibility with your teams.

And again, as you're the objectives for your project, as you're developing your facility, you're gonna consider, hey, are you working for a for-profit organization or are you working for public or a NGO?

And based on that is gonna have some different management that you will have to execute for your project plan.

And then I'll just run, I know we're getting a little bit towards the end and again, I will ask Ray to share these slides with you so that you have these as a takeaway, but think about the variability of the stakeholders, and we've kind of chat or kind of chatted about this through this hour.

Really considering other people's perspectives, bringing that perspective in to the mission of your design and of your plan and managing these performance indicators.

I'll go kind of I think quickly through here, but you know, from an owner and developer perspective they really want everything, right?

They want the low cost, they want the high quality, and they want it done yesterday, okay?

That's what the owners are looking for.

They want a high rate of return.

So again, as designers, as planners, when we can show owners, hey, yes, this is gonna have an investment cost but it's really gonna benefit in the long run.

I think that's wins for everybody.

The designer, right?

You're looking for a reputation.

All the architects that are gonna go into practice in the future.

You know you want to build a high quality, you wanna get repeat business, right?

So you do wanna manage really as tightly as possible.

You can that triangle of key performance indicators, high quality, you know, within budget and then within schedule.

And you wanna make some money too.

And the builder and the contractor, they definitely wanna stay within budget.

They definitely don't wanna go over schedule because every day that they go over the schedule, there can be penalties such as liquidated damages, plus they're not able to start their next job.

So they're really, really trying to get the project done and then get onto the next project.

So from the owner's perspective and from the designer's perspective, it's really important that we work with the constructors to make sure that we don't have any shortcuts on quality.

And then this is just a summary together.

Ray did ask me to speak a little bit about the Craig Joint Theater Hospital, which is in Bagram, Afghanistan.

It was, I think it was...

So we started groundbreaking in 2005, I believe it was completed in 2007.

And it was in operation until 2021, 2022, whenever US forces were left out.

The hospital is joint.

So a lot of times you'll think, hey, that's Army, Navy, Marine Corps, but it was more than just joint, it was combined and combined indicates that it's multinational and that mission was a NATO mission.

And so that hospital served all the NATO members who needed care there in theater in Afghanistan before they could be evacuated out.

And as well as subject to the availability of the resources also would treat local Afghan nationals as well.

Some general issues just to take away, and we've kind of talked about this, the scope, what's it gonna cost?

Risk management is another huge field.

I encourage you if you have time while you're here to take a course in risk management, I think that will definitely help in your decision making process for your designs and your projects that you work on.

When you can think of things in the context of risk management.

We've talked about resources, and a comment that I'll make on resourcing.

And I think y'all have seen some of this, and I even had on one of my little notes here for the Walter Reed, which was originally built in 1938, and in the 2005 BRAC, the estimate was that by closing down the old Walter Reed and shifting over to Bethesda, that the government could save $172 million less annually in operations.

It was gonna be at a cost of $900 million to shift.

But the actual realized cost by 2011 when the shift was finally made was 2.7 billion.

The almost triple cost increase was attributed to logistics.

Increased in construction costs, center of gravity, root cause they asserted was basically because of Hurricane Katrina.

This was 2000, you know, this was before 2011.

So between 2005, 2011, right?

Increased construction cost.

Nothing compared to what we've seen in these last couple of years.

So I'm sure that in your architecture courses you're taking materials classes to look at what are goods design solutions in the selection of materials that are readily available, that are not reliant upon long-term shipping that really can make a difference in your project planning.

And it can affect again, all of these drivers, your cost, duration, scope, et cetera.

And then kind of that bottom line question that kind of always is an issue is who gets how much of your objectives met, right?

Not everybody is gonna get everything.

So how do you best manage to try to give or try to see that your project plan, that your design meets the most objectives for the most people.

And then just a couple of issues.

Pulled this from one of the websites, it's down here that just said, hey, some of the recent hospital construction project planning issues, again, we talked about that, right?

Complexity during construction operations.

Protocols, I know y'all all have taken classes on healthcare associated infections.

Installation of expensive equipment.

How much does the MRI cost?

Anybody know off the top of their head?

(student speaking faintly) No, no, much more than that.

Generally, well let's say 10, you know, on the order of you're looking at million plus, okay, 1 million, you know, there may be some escalation there, but you know you're looking at seven figures, okay?

And then, oh, by the way, what happens when that installation... What can really mess up that entire piece of equipment, one piece of equipment.

What can really mess that up?

What's inside of an MRI?

- [Student] Helium.

- Helium.

So if that is not kept at the appropriate temperature, you can very quickly expend a lot of money.

New technology enabled strategies, okay?

For team coordination.

And I think we've all kind of, you know, especially here on the university, looked at what technologies are different that we can use to try to advance our project.

And then was happy to see that they had something on AI.

How can generative AI show you real time progress?

How can you best show your design?

You know, think about that.

Has anybody ever been in one of the 3D bubbles where you walk to the middle, A lot of times they'll use them for veterans who are working on their gait, their walking gait.

We have one.

I think there's a bubble somewhere on campus here.

I don't know where it is, but I've heard something about it.

But how can you bring your clients, what kind of generative AI can they put on and do a walkthrough when you're looking at your design?

And then best practices.

Again, we've talked about investment.

Doing as much side investigation as you can.

And I tell my students, I say, you know, be the spy, be the intel officer.

Go find out and research as much as you can because that's gonna give more informed decision making to the plan and design.

Safety, safety, safety is always important.

Keeping up with healthcare trends and understanding the risk of infection.

This is the DeBakey or the, it is currently now the DeBakey Medical Center, VA Medical Center in Houston, Texas.

Originally 112 acre site.

Again when this was allocated for construction, nothing out there.

And of course we've had progress and so now they're paved with parking lots everywhere.

But great VA Medical Center.

I encourage you guys, y'all are close to the Houston area.

If you get a chance to go down there please visit the DeBakey Medical Center.

And this was some of the newer construction and this is the current entrance.

Share what you know.

Share what you know.

So I encourage you go back to your, I know some of y'all late for your next class.

We have a TA in the room.

So as you go to your next class and through your tenure here and as you go into practice, share what you know.

That will certainly help improve the overall design.

And I think with that, thank you very much for your attention.

And Ray, thank you so much for having me here today.

(audience applauding) - Autumn, that was amazing.

Thank you.

That really was terrific.

Questions, we'll just take one.

(student speaking faintly) What?

- [Student] We do not have any questions online?

- No online questions.

How about here in the studio, question for our guest?

- [Student] Do you feel attached to like the multi (indistinct) place in Afghanistan after you pulled out?

- Yeah, my personal opinion is, you know, I think that there could have been probably better diplomatic solutions that were taken multi nationally than what was executed.

But I will have to say that if you get an opportunity to work with the DoD in healthcare planning and design, it's a wonderful group to work with.

And you know you do get to look at a whole host of different considerations.

You know you've got everything that you do that you think about for a normal hospital, but you have additional factors because of the nature of where they're trying to deliver, the safety that they're trying to guarantee and things like that.

So if you have an opportunity, I highly encourage that you work with the DoD.

- One more.

Autumn, I'm curious, and I should hasten to add, Autumn is also on our faculty in civil and environmental engineering.

I neglected to mention that in her introduction, but it should have been obvious from the depth of her comments that she is in that field and that it showed beautifully.

Question.

For those who are looking at the field and looking at people who are experts in it, what would you say to them are the greatest opportunities for research to change the way you do things, or to reveal some new insight that could transform how projects are managed or delivered?

Is there a field of study that they could monitor, or literature where things are published where they could sort of dial in to where change is happening?

- Yeah, great question.

Great question.

And I would say it's multidisciplinary, right?

And you know, and I would encourage you all to be lifelong learners.

Never stop opening the books.

Never stop listening to other conversations.

I talked about the creativity research of the fields of creativity.

I talked about the Cynefin framework.

When you're looking at from simple problems, when it goes all the way to such complexity and then it gets into total disorder, your known knowns all the way to your unknowns and unexpected, the more that you can push your brain to think creatively, to think outside of the box, you're training yourself, right?

So I tell my soldiers, I said it's like doing pushups.

If you wanna do good pushups or whatever exercise you like to do at the gym, if you wanna be an expert on it, you have to train it.

We don't have today, but perhaps on Zoom we have Kirk Hamilton who is a faculty emeritus.

And one of the lessons that Kirk gave to us and resonated with me and I will never forget, is he said that as he would study things, he would cut 'em out of the newspaper and he would keep a little notebook.

Well, we may not take a newspaper today, but we have access to so much more, right?

And so whatever form that you save your knowledge in your knowledge management, work on expanding that, you know, work on saving those every single day.

Read about things that are not in your normal operations that you do, not in your normal field.

Get outside, listen to others, bring those together and then share information.

- Perfect.

Well, our time is up.

I wish we had more.

But it's been fun.

Appreciate the presentation, the effort that went into it.

Beautifully delivered.

Thank you so much Autumn for joining us.

One more thank you for Autumn.

(audience applauding) We'll be here next week with another great speaker, so please join us again.

Thank y'all for being here.

Have a great weekend.

(upbeat music)