- Howdy, and welcome to the Architecture for Health lecture series.

It's great to have you with us.

We've got a terrific program for you today with two presenters from Ballinger.

First, I'll introduce Lou Meilink, Senior Principal at Ballinger, an interdisciplinary design firm in Philadelphia.

His passion is architecture for health.

Long-time leader of Ballinger's healthcare practice, trusted partner to a number of healthcare institutions you would recognize, and a recognized pioneer in evidence-based design.

And his practice centers on the intersection of design excellence and clinical expertise.

Joining him on the stage today is Courtney Petrella.

Courtney, it says here, is not afraid of constraints.

I love the way that sounds.

A deeply analytical designer and planner, she takes pride in finding the perfect puzzle piece to fit into the rest of the puzzle to make it work.

In 2020, Courtney became a full-time member of Ballinger's healthcare planning studio and has played an integral role in healthcare planning efforts since especially at Inova.

And so, would you help me welcome Lou and Courtney.

(crowd applauds) - Well, howdy.

- [Member] Howdy.

- Well, Courtney and I are delighted to be here today to talk to you about the power of design collaboration and relationships to transform healthcare.

But we're also here to talk about Courtney and really how she has really skillfully navigated the first few years of her career at Ballinger.

So, a little bit about Ballinger.

So, single office in Philadelphia, 250-plus professionals, architects, interiors, and engineering.

And we really have a culture of innovation.

And that's really where the blend of design excellence, clinical excellence, and planning really come together and help our firm to thrive.

And if I was to characterize our practice and our team, they're really challenge seekers.

And not just for the sake of the challenge, but really for the potential that lies within the solutions.

Our practice really focuses on complex buildings with complex programs.

And we work across a variety of spectrums that you see here.

Obviously, healthcare is a very significant part of our practice.

We're very privileged to work with some of the top academic regional community hospitals and health systems around the country, some of which you see here, and many of which we've presented here at A&M over the years.

So, our learning objectives today are as advertised, so I won't read all of those.

But we are going to use a case study to kind of make these learning points with the Inova Health System and the journey we've been on over the last three years.

But we're also going to do that in the context with how Courtney has contributed during that time and how her role, responsibility, and different areas that she's participated have evolved.

And you'll hear a lot more about that.

So, to set the stage, we're going to talk a little bit about where are Courtney and I in our careers and how have we worked together.

And then I'll do a little bit of overview on who is Inova.

So, I graduated from Kansas State University and I've been with the firm for 36 years.

Courtney?

- So, while Lou has been with Ballinger for 36 years, I've been there for just 36 months.

I graduated from Cal Poly in San Luis Obispo in 2020.

And while I've only been with Ballinger for three years full time, I did have several great internship experiences that have propelled me into my role now full time.

And knowing that I was interested in healthcare design, going into my internships, Ballinger helped to curate each of those experiences so they built on one another as I returned each summer.

So, in 2017, I started with a small ED renovation for the Children's Hospital of Philadelphia.

In 2018, I worked on a full floor ICU renovation for the Cooper University Hospital.

And in 2019, I worked on a new inpatient tower for the University of Rochester Medical Center.

And so, each of those experiences built on one another and prepared me for the work that I'm doing today with the Inova Health System.

- And we like Courtney so much from internships.

Before her last year in college, we offered her a full-time position, and she accepted before even starting.

So, she could just focus on her studies and know she'd have a home when she graduated.

- So, I think it's really interesting when I look at the timeline of my time at Ballinger full time in relation to the Inova Health System project timeline, which kind of run parallel.

So, when I joined the firm full time in 2020, Ballinger and INEAD had just been accepted for the Eastern Region projects for Inova.

So, as we started the programming phase, I was working on creating presentations for some of their strategic planning meetings.

As we moved through schematic design, I was attending user group meetings and taking meeting minutes.

And as my role continued to progress, I was promoted to healthcare planner in January of 2022.

And as we moved through design development, I was actually able to start leading some of our user group workshops, both in person and virtually.

And now, as we phase into this construction documents phase, I'm continuing to create content and even present at some of the strategic planning meetings that I was originally starting out just making presentations for.

- And then in addition to how Courtney's career so far has tracked with the Inova Health System, all of that tracked with the pandemic.

It's interesting, the first time that we met Inova was in March 13th on Friday in 2020 when things were starting to get a little bit scary.

But we met a few folks there as part of the selection process.

And of course, Monday, March 16th, the world shut down, Philly shut down, all of our offices shut down, literally just a couple of days later.

And after we selected, we went almost a year before we literally met anyone additionally with the client, given the pandemic.

And we'll talk about some of the tools and things I'm sure many of us have used and how we navigated through that process.

But after we met Inova, after the first year, I kind of joked that we had really bonded on Zoom.

We hope they like this as much in person as our Zoom personalities, but it's all good.

It's been a good relationship.

So a little bit about Inova.

So Inova is a very large, highly ranked health system in Northern Virginia, the metro DC area.

And they have many hospitals in many locations as you see in this map.

Our work focused more on the Eastern region, which you see kind of in the dark blue dots.

And their mission to really provide world-class healthcare every time, every touch.

But what really attracted us to Inova and really wanting to work with them was not only their mission, but their mandate.

They really wanted to look at providing a people-centered, high-value, seamless system of care, really integrated across their whole system, of which the work in the Eastern region would be that kind of flagship and the start of doing that.

And really looking at reinventing their brand, transforming their care delivery model to provide a consistent brand experience.

And they really realized the value and the power of design and architecture to make transformational change.

And that really attracted us to them, and them, I think, to us.

So here, and again, I won't read all of these.

You see some of the guiding principles that we set out from the beginning about being integrated and really looking at having a consistent experience in privacy, really emphasizing teamwork throughout the system, leveraging technology, which was very important.

And then we'll talk a little bit more about standardization and creating a key room kit of parts that they could use throughout the health system.

So a little bit about the Eastern region projects.

So it was very interesting to start a project where we were working simultaneously on three sites doing six buildings all at one time.

It's a rather unique opportunity to do with one client and developing, and at the same time developing kind of these design guidelines and standards.

So if I start with Oakville to the right, that was a new ambulatory care gateway building and a new area for them, and we'll talk more about that.

And then there were two hospitals, Alexander Hospital's replacement hospital, and Springfield Hospital is a new hospital.

But the goal is it was one hospital on two sites.

So you'll see as we go through today how those two sites work together really as one hospital.

So now Courtney's going to talk a little bit about some of her first reflections in her career at Ballinger.

- So thinking back to the first couple of weeks and months working on the Inova Health System, I think about some of the tasks I was doing, just attending internal meetings and listening in to some client meetings, taking meeting minutes, and assembling presentations.

And as I reflect, it was a unique opportunity to observe and absorb information that I've now been able to use as I'm now working.

So I think, for example, my time in my internships and also listening into internal meetings allowed me to understand the firm workflow and the firm file structure and also understand our project team roles, which allows me now to work more efficiently, understand best practices, and know who on the team is the best person to reach out to.

And when I think back to attending meetings and taking meeting minutes and assembling presentations, I realize now that all of those things allowed me to absorb the context behind major decisions that were being made at an executive level for this client, and also establishing my relationships and rapport with the client, which has given me the foundation to now feel comfortable to lead user group meetings and even present ideas to client leadership.

So I'll walk through some of the early stages of the programming phase and things that I was working on.

We went through a process of benchmarking major departments within each of the hospital campuses.

So here on the screen is an example of our benchmarking for the inpatient units.

We were looking at ICU, med-surg, and observation being acuity-adaptable for each.

So we peer-reviewed different other peer institutions as well as some of Inova's recent builds, looking at things like long views and natural light at the end of the corridors and understanding what DGSF factor allows you to have those types of unit considerations.

So we worked with Inova for multiple departments on what is that perfect DGSF factor that gives them everything they want.

We also spent a significant amount of time looking at the inpatient room module, knowing that the inpatient floors generally make up about 50% of the building.

So I know the idea of where the bathroom is placed is always up for discussion when looking at the inpatient unit.

So you can see on the left, in the outboard configuration, the bathroom is located more towards the exterior, so that frees up a lot of space for the decentralized caregiving and the caregiver zone in the room, but it does limit your family zone and the views and access to natural light.

In the inboard configuration, the bathroom is located more towards the interior of the building, which maximizes your views and access to natural light, but it does limit the frontage of the room and the caregiver zone.

And then we also looked at the midboard configuration, which we feel is kind of the best of both worlds, where you locate the bathrooms kind of nested in between of two rooms, and that way, neither the family zone or the clinical zone is compromised.

And while this does require a wider structural grid, it was something that Inova felt would be a market differentiator for them, and so we moved forward with the midboard configuration.

So you can see here, we created multiple key room types that we use throughout the programming phase.

This is the midboard configuration, and these rooms all meet ICU-capable restrictions, so that basically any room can be flexed to be ICU if needed.

We also did key room types for our emergency department, our prep rec PACU, which are all private rooms, and part of Inova's guiding principle is about bringing care closer to the bedside.

We actually incorporated decentralized caregiving in these rooms as well, which was another market differentiator for them.

For our procedure rooms, we looked at three different sizes, and we used those as our puzzle pieces as we started to assemble the procedure platforms on each campus.

So there's a minor procedure room, which is around 300 net square feet, our standard OR, which is around 650 net square feet, and an interventional OR, which is about 1,100 net square feet.

So again, knowing each campus we were working on has different needs in terms of procedure rooms, we were able to use these key rooms as pieces as we assembled the procedure platforms at each campus.

And so we used those key rooms and the DGSF factors that we worked with Inova to determine in order to start to put each building together on the campuses.

And by doing this, we were able to confirm that our space allocation percentages for inpatient versus diagnostic and treatment and support all were still aligning with benchmarks.

And so when we did that for each of our six buildings across the three campuses, and the total square footage was just under 1.5 million square feet.

And so as we started into schematic design, we worked with Inova to create very many work groups in order to get feedback on each of these spaces from the actual end users.

And because Inova was working to create a system standard that they could apply to their entire health system, they didn't wanna restrict the work groups to just people that may be working in these buildings.

They opened these work groups to everyone across their system so that they got a good representation.

So given that we were working with people from across Northern Virginia, and given the pandemic, a lot of our initial work groups were all online, which required us to really leverage technology in order to make progress and understand their needs.

So we utilize programs like Nero to do patient flow diagrams with icons and arrows that we were able to move real time during our meetings.

We also utilize plugins for Revit to allow us to make a graphic room-by-room programs.

We felt these were easier for the users to digest compared to the tabular versions sometimes we see.

And in a limited capacity, we even use virtual reality design reviews, which allowed our clients to actually walk around within our models with their personal devices.

And I think specific to Inova, we utilized by around this time, the pandemic restrictions started to lift, and we were able to actually do in-person mock-ups.

Inova had a space available in an existing building where we were able to build out 14 of our key rooms and have our user groups at that point come in and understand the scale of the room and talk through the details.

I think a lot of the work group members were so surprised at how large the rooms were after looking at them so tiny on the screen.

So it was great to meet all of them in person and then also really talk through the details of the rooms.

And we call this Inova's design laboratory because it really has been something that we've gone back to time and time again to make updates as we progress in the design.

And I think we've also gone back and taped out multiple other rooms that didn't make the initial list.

So we're continuing to use the space.

As of just last week, we were in that space working with our client to figure out the details.

- So now we're going to go into a little deeper dive on a few of the projects, and we're going to start with Oakville at Potomac Yard.

So this is an ambulatory gateway building that sits just across the Potomac from D.C., just down from Reagan Airport.

And it was pretty interesting that it's a heavy residential developing area there at Potomac Yard, and we actually share a superblock with a residential building.

So the parking below grade and the base is all being built together, and you can see in the inset image to the right is the residential, and to the left is the ambulatory care building.

And it's about 100,000 square feet with a freestanding ED, with an ambulatory surgery center, and two floors of MOB.

And this building was the first one out of the gate.

Given the schedule with the developer and the timeline, it really had to move quickly, and it kind of bore some of the responsibility for setting some of the early identity and brand aesthetic.

Again, I mentioned they really wanted to use the power of architecture to create a brand identity for Inova.

So you see here some of the gentle curves and kind of humanistic nature, and you see kind of the use of materials you're going to see throughout all of the buildings that we're going to show you today.

And it really developed, as you see here, in developing kind of this language to really look at the idea of a heart.

So the idea there would be a central space in every building that was really Inova heart, which has become known now as the Inova Commons, became very important.

And the use of biophilia and access to terraces and landscape you're going to see throughout the project.

So this first project really bore some of that responsibility of kind of carrying that initial view of design.

And we had a number of visioning sessions with their leadership and design steering committee to really talk about what did they want that identity to be.

And we used benchmarks of different design and architecture to really see where upon the spectrum that their culture would fit into.

And then we developed a kit of parts.

So a kit of parts of language that you see here, even so much as a canopy.

You'll see some of these swooping canopies in the ambulatory care buildings that you'll see at each one of these.

That became kind of a signature in a kit of parts.

An idea of a civic porch that you're going to see in all the hospitals that leads to Inova Commons.

So it really developed so over time, any new buildings can look at the kit of parts.

And it wasn't to copy or be exact.

It was to create a language.

So here you see three different ambulatory care buildings.

Again, Oakville is a freestanding building.

The other two buildings are both at Alexandra and at Springfield are on hospital sites.

But if you look, while they're not exact, you can look at those and say, I see a brand there.

I know that I'm at Inova.

And that was really their goal.

So now let's go inside, Courtney.

- So similarly, we also created an interior kit of parts to really reinforce that seamless sense of care and knowing that you are at Inova.

I think one great example of this is our ambulatory medical office building configuration.

Early on, we created a framework for this configuration.

And Inova challenged us to create a flexible exam room configuration so that regardless of the number of exam rooms a certain specialty is using, that there's flexibility across the floor for the future.

And so you can see here, we also prioritize the idea of onstage and offstage.

So the corridor to the north is designed for patients to travel from the elevator through the waiting room and along that corridor into the exam room pods.

And similarly, on the south is an offstage corridor, also light-filled, for the clinicians and the team members.

So they may access the exam room pods from the south.

So you can see here, this is the third floor at Oakville, which was designed around primary care, how we've now taken that diagram, that configuration, and applied it to a real building.

So again, you can see the light-filled corridor to the north entering into the four distinct exam room pods and the offstage corridor to the south with team member and office space.

I'll also note that one of Inova's guiding principles was making sure that their team members had access to natural light and spaces for respite.

So on each of these floors, we've located the staff lounge, which on this floor is in the top right corner, to have access to light and actually a great view over to the adjacent park.

And so similarly, you can see how this module and configuration has been applied to the other campuses at Landmark for specialty care and at Springfield for MSK-MOB.

So I think dependent on the site constraints, we were still able to accommodate the general configuration in order to create standardization throughout.

And this does allow for some flexibility.

For example, at Springfield, at the MSK-MOB, given its MSK focus, we were able to incorporate x-ray rooms and casting rooms within this module.

And here's just an example of one of the waiting room spaces of those ambulatory care centers.

- So now we're going to touch on the two hospitals, and again, two sites that really work as one hospital.

And we'll touch briefly on Springfield, and the Springfield campus is really a community hospital.

So this is a 30-acre campus.

To the far right was the only existing building that Inova had there, which was a healthplex.

So this is a 144-bed community hospital, full service, that you see kind of to the right at the entrance, and to the left you see the MSK-ASC-MOB, had a real focus on minimally invasive surgery and orthopedics.

And given the 30 acres, we had height restrictions here, so we call this the garden campus.

And now we're going to do a deeper dive on Alexandria Landmark, which the old Landmark Mall was kind of a historic mall in Alexandria.

That entire site now has been demoed for major redevelopment for residential multi-use, and within that, Inova received 10 acres to develop the new hospital.

So this is a much more vertical campus, and this is a view kind of looking down the greenway in the Inova precinct.

And this area kind of helps you to understand the construct here.

So you can see the hospital there to the left.

It's a 231-bed hospital.

You can see in the foreground to the bottom, the SCC that Courtney just talked about, and then you see the cancer center to the right.

So overall there's about 830,000 square foot on this campus and about 1,500 parking spots between below grade and above grade.

So I'm going to do just a little pictorial, so here's more at grade.

You can see walking up the greenway where you're coming between the cancer center to the right and the SCC, and you see the hospital kind of creates that vista or termination point along the greenway.

And now here you're seeing the Civic Porch, that kind of kit of parts that we talked about, and the Civic Porch is welcoming, inviting, and really bringing you in then to the Inova Commons, which is that heart or center that they wanted all of their facilities to have.

And here you see how the outside has come in, which was another goal with the gentle humanistic curves, the use of wood, really being light and airy.

So we're going to kind of walk through this building at a very high level and hit a few key points.

So here you see this floor here at the first floor is almost a 90,000 square foot footprint, and you can see to the top right the yellow area where you come into the Inova Commons, has various amenities, the conference rooms as you come down.

What I'm going to focus on here is to the far left is the emergency department.

So you see in the emergency department there in red, we created three standardized modules that each have 12 private exam rooms and each have their complement of support spaces within a support core.

And you can see we're doing this across multiple campuses of creating this caregiver module, so it's about operationalizing, it's about caregiving, and it's always about design, of course.

And so we've taken this to both campuses.

You can see the imaging is just to the right of that in red, so that can be used for inpatients as well as the ED.

The goal at Inova is there's very little outpatient imaging being done on an inpatient campus.

That's really being done on easier to access facilities in the outpatient environment.

So we did a lot of mock-ups, as Courtney noticed, and here is the emergency department room.

We had folks from five different hospitals come through, and we're actually working at one time on four different EDs, so they'll end up building about 150 of these rooms, so pretty important to get this prototype correct.

And we've gone back and continued in our meetings to evolve it and to tinker with the design.

If we move up to the second floor, so here we are on the procedural platform.

It really was a goal to not have surgery, endoscopy, interventional all in silos.

So we truly have created here a procedural platform where they're all in one space, and they share the private prep recovery modules that you see here, which are also private rooms, and they're developed into neighborhoods.

And, of course, there's the minor procedure that's outside the red line, the four rooms that are there in the middle, and then there's the 16 overall operating rooms, hybrid rooms, and interventional rooms that you see in green, all around a clean core model and a lot of effort.

This was a big cultural change for them to kind of put everything in one procedural platform.

We did a lot of benchmarking.

We did peer-to-peer from some of our clients that we did this with so they could really understand how this could work.

So we're very excited that this is a new initiative for them.

And, of course, we did a lot of mock-ups wanting to design surgical rooms to be flexible.

So our standard 650-square-foot room that you see to the left, we did a dozen surgical scenarios through there, really capturing what could be standardized versus what needs to be unique, and it was very enlightening to try to create the most flexibility we could.

To your right, you see there we were modeling an interventional room, but what we did is because we do a lot of 3-D modeling.

We've done that for almost 20 years and really enjoy it, but because of the pandemic, we couldn't do it earlier in schematic design.

So in begin design development, we still brought that to the mock-ups because being able to see the whole thing at one time and kind of aerial and move the pieces, that really helped orientate them when they went to the rooms and were able to model that and to work back and forth.

So again, looking at all the tools in your toolbox to work with your client.

And then here's a picture of the waiting room coming into the procedural platform, which is right off the two-story Nova Commons.

And while this will be a wonderful place to be, we didn't want folks to just sit there for hours necessarily, so they will be linked with technology, they're handheld, and they'll have other opportunities.

- Yeah, so the open stair that you're seeing here will be connected to the Nova Commons on the ground floor.

It also will be connected to the third floor, which has a public terrace as well as the server and dining space that serves the whole hospital.

I'll also note here that there is a team-member-only terrace.

Again, one of Inova's initiatives is to make sure that their team members have access to natural light and respite, so they now have a spot where they're able to take a break and get some fresh air without ever having to leave the hospital.

And so here's a view coming up from surgical waiting to the third floor with the public terrace, and also a view of our server and dining area.

So as we move up through the building, another great example of standardization that we've done between both campuses is the inpatient unit itself.

So we've taken our mid-ward key room configuration and applied it to two 24-bed units, which you see here at both Landmark and at Springfield.

You can see in both we also are taking note of the onstage and offstage with a public corridor to the right of the elevators at both sites and an offstage corridor to the left, both with access to light.

We also did a lot of rigorous studies on the support core of these inpatient units to make sure that they are standardized across both sites.

So while we have stairs and shafts and shear walls in different locations, the order of the clean supply, the meds, the nourished, and the soiled are all the same at both sites in relation to their open team stations.

So what that allows for is if a nurse is working at Landmark at one day and the next day they happen to be working at Springfield, they know where the clean room is because it's in the same location.

We even went so far as to create a kit of parts for these types of rooms, our clean supply, our medication, our soiled, things like that, and we actually went back to the mock-ups and taped these out to really verify with the users that they were the right size and had all of the right supplies they needed.

And so again, not only can a nurse work at Landmark and at Springfield, the clean supplies in the same room and also, in theory, the supplies they need are going to be in the exact same location.

So that really opens it up for Inova to be able to flex their staff and still maintain efficiencies.

And so here's a look at Lou and I at the inpatient mock-up.

And I'll note here, again, with this being a design laboratory, you can see that in the decentralized station area we originally went in with a fixed countertop and when we had users come in, they talked about the ability to quickly touch down, stand at those positions.

So in our new configuration, you can see that we've now removed those countertops and just are using a wall-mounted sit-to-stand desk for them.

And so as we moved through design development, we created a little bit of a deeper dive into each of these key rooms by looking at all four wall elevations with the users and making sure that they had everything they need.

And here's an early rendering of our design concept for the inpatient corridor.

And you can see we've put a lot of time and care into the footwall of the patient room, which you can see here is clad in wood, just knowing that that's the wall that the inpatient is looking at the most.

And we also have the decentralized stations and the triple sliding doors, which will have integral blinds in them for patient privacy.

- So as you can imagine, to be doing six buildings at one time on three different sites, it takes a very significant team, all working closely together, all working very collaboratively.

And I just have to say that the Ballinger ENIA team has really worked seamlessly together.

Our firms have a little bit of a history and a lot of shared culture.

And I'd like to show this picture because at the end of schematic design, we got together to have a celebration.

And it was interesting because of the pandemic, not only had most of the folks in our firms not met each other, they had met each other in the same firm because new folks had been hired during the project and during remote environment had never met each other.

So it was quite a moment to kind of all get together here just off the Delaware River and have a moment to reflect.

And I think you had another observation too, Courtney.

- Yeah, I think it was also really interesting.

We heard from our client pretty early on that because we were all on Zoom, they weren't really sure who was at ENIA and who was at Ballinger.

And that really helped diminish the lines between our two firms.

And we work really collaboratively.

And I think that really had an impact.

So looking back on working on Inova the last three years, I think my biggest takeaway is kind of the way I'm going to be approaching projects in the future.

I think when I started right out of school and I was told I was going to be on this project, my first thoughts were what type of building is it?

Where is it?

And when is it going to be built?

But I think after working alongside Lou and working with Inova and really getting to understand their needs, my questions moving forward are going to be more so, why, why is this building being built?

What are your goals?

And who, who is this building serving?

And what are their goals?

And if I take a moment to also just reflect on my three years at Ballinger, I do have to take a moment to credit Lou for being such a mentor and then also crediting Ballinger for creating a culture that really made me feel like I had a voice early on in my career and having that access to leadership, regardless of how early or how long you've been there.

And so with that said, I will also plug for any of the students, we are still accepting applications for our summer interns.

And for those of you that may be more interested in the research, and we are still accepting applications until Monday for a fellowship opportunity for the summer as well.

- So thank you.

- Thank you.

(crowd applauds) - [Ray] Questions?

- [Member] Ray, maybe they can send a fellowship application to Cindy and you so the students can get it because that was the first I knew about it, maybe.

- Yeah, I think, I think the application's available on our website as well.

- [Member] It's due Monday?

- Yeah, we were accepting applications for internships beyond that date, but that was just for the fellowship.

- Yes.

- [Member] Question for Courtney.

Do you intend to pursue your licensing as an architect?

- Yeah, definitely.

I've been, throughout these last three years, I have been acquiring my hours as needed and I also have started to take my exams.

So I'm a little bit, I've passed two so far, so I'm still working on that.

But yeah, that's definitely part of my plan to be licensed.

- [Ray] Other questions?

- [Member] Sorry, can you repeat the question from just a little while ago?

- Yes, the question moments ago was do you intend to pursue your architectural license?

And Courtney answered in the affirmative.

- [Member] Do you have a placement for Courtney to- - Can you just come up here and ask it, please?

That might be easier.

It's fine, you could, that's fine.

Oh gosh, not there.

No I'm just kidding.

(laughs) Come on, come on, come on, it's fine.

- Sure, my question is for both of you, but for Courtney.

Where do you get and how do you get into medical planning at the beginning of your career versus something else?

- Yes, so as Lou mentioned, that Ballinger has a lot of kind of challenge seekers.

I think when I was going through school, I felt that I liked working within constraints and how it's more interesting to try to figure out how to make something work really well when you have constraints that you're working with.

And I felt sometimes when I was given no constraints, there was too many opportunities.

So I think that for me, I was really attracted to the idea of healthcare design and the ability for design to really make transformative care and I think, yeah, that's probably it.

- Well, it's interesting, we all have our journey to health and for me, when I came to Ballinger, I won't take a lot of credit, I got out of school and I was put on a healthcare project and I wondered is that what I want to do and what's that all about?

Seems to have a lot of restrictions and codes and so I went to survey the first hospital I worked on, which was in a pretty tough economic area and after walking out of surveying the hospital, my life's calling came about.

I realized that there's any building type that needed design, that needed architecture, it had to be hospitals.

They were just not very good places.

You kind of feel that you might get sick because you were there versus not.

So anyway, that was how I got the bug very early that I would have never predicted.

- Yeah, absolutely.

And I think also now that I've worked more closely on a project and with the end users, I think healthcare is a very unique sector of architecture and where you really need to rely on the end users to give you feedback to make sure that what you're doing is going to work for that.

So I think that interaction, being able to interact with the end users has been really, really great.

- That was a good question.

Are there others?

I'll ask a question to both of you.

As you think about your experience, what have you been able to especially contribute because you're a recent grad and not the senior designer that eventually works their way into medical planning?

What is it about being a recent grad that was explicitly a value that you brought because of the early stage of your career?

And Lou, I'd like to hear an answer on that from your perception of what she brought as well.

Courtney, you want to go first?

- Yeah, sure.

I guess my first kind of initial answer to that question would be I know that especially given the pandemic, we had to leverage a lot of technology in all of our user group meetings.

So I think just being able to be efficient with technology and thinking of ideas of ways that we can be creative and accomplish things.

I think, for example, the graphic programs that we were able to do that kind of required a lot of different analytics in Revit and plug-ins that I think had I not had the background in Revit coming out of school, would have been a lot more difficult to be able to apply to that really large scale.

I think, yeah, I think the technology and also just being able...

I think a lot of the work that we do for Inova, they have a lot of kind of series of presentations to their executive leadership groups.

So with that comes a lot of presentations to them and being able to kind of quickly assemble those presentations.

And over time, I've started to learn the way that we like to present things to them.

We like to usually end with the ending and then we'll tell them why we want them to do that.

So as I've gone through, I've been able to kind of quickly assemble these presentations for these major decisions that they're making for their hospital.

- [Ray] Great.

Lou?

- Ray, having worked with Courtney during one of her internships and then with Inova, she brings so much passion and energy and tirelessness to the role.

Look, it is hard work that we do doing healthcare and the healthcare environment.

And the caregivers were under, they're heroes.

They were under such struggles during the pandemic.

To take time to meet with us it's pretty amazing what they went through.

And Courtney is being very modest.

And very early on, she was working with me on all of the senior executive leadership meetings, then starting to participate in the workups, being in the meetings.

Even other senior folks on our team weren't there, but there was Courtney.

And having that, so I think Courtney was able to leverage, as you would say, everyday task into opportunity.

Courtney was looking beyond.

She had the ability to think strategically beyond the task at hand to beyond the opportunity that came from that task.

And so you could see a lot right from the get-go.

- Well, that's a compliment.

Other questions?

Yes, George?

George, can you come make it up here, please, sir?

- It may take an hour to get there.

Thanks, Ray.

And thank you both for a very interesting presentation.

My grandkids, as you know, live in Philadelphia.

So could we, Courtney first, then Lou second, talk about the excitement of the city of Philadelphia for someone coming from another part of the country, which you both do.

Thank you.

- Yeah, absolutely.

I think that Philadelphia is a very unique city and that it has so much history.

But with that history comes a whole sense of culture.

And while it's not kind of stuck in time, it's evolved over time.

So you kind of see how the layers of the city have built up over time.

And there's so much to do.

And our office steps from Independence Hall and other things and City Hall.

So there's a lot to do, and you can always find a good spot for a happy hour.

(laughing) - Most importantly.

Yeah, Philly is a very dynamic city.

I grew up in St. Louis and went to school at Kansas State.

And I know when I moved to Philly, my parents were like, Lou, what are you thinking?

What is that all about?

You've never even been there before.

But sometimes you take a chance in life or the good Lord leads you.

And Philly, even over the years, has really developed.

As you said, I'm a big history buff, so I love the history in Philly.

You could walk two blocks from our office and be in Independence Hall.

And it's just amazing.

It never gets old.

Maybe because I didn't grow up there.

And even the restaurant scene and everything there, it's a very progressive city.

And it's also very close to things.

It's close to New York.

It's close to the shore.

It's close to D.C.

It's very geographically located that you could kind of touch a lot of points.

- Questions from the audience?

Courtney, I have a question for you.

You had to have had some level of expectation leaving the university and entering practice.

With the opportunities that you found at Ballinger, what was the biggest surprise, things that you got to do or be a part of that you didn't see yourself being allowed to do or to work on as early as you were able to do it?

Where were the surprises?

So I think definitely I wasn't expecting coming out of school to be able to have such a close relationship with our client.

And of course, that was a slow progression.

But when I came out of school again, like we mentioned, I was working on some of these strategic planning presentations, and through my work there, I was able to kind of be in the pre-meetings, or you would say, and through that, I was able to establish a relationship with our clients and even, since so far as now, like leading client workshops and things like that are just things that I just never thought I would have the opportunity to do so early on.

But again, I have to credit Lou for his mentorship, and I try to emulate a lot of the things that I watch him do early on in my career as I move forward in mine.

- Well, it says a lot that Ballinger trusted you with a client early on.

I've noticed over the years, I'm sure others have as well, that it isn't just about technical competence, but for a firm to trust you with a client relationship says so much more than just about your technical skills.

It's, you don't get trusted with the opportunity to work with a client unless the firm that you represent is comfortable that you will not misrepresent or dishonor their reputation.

So to be given that opportunity early speaks volumes.

- [Courtney] Thank you.

- Any other questions, comments?

So how far along is a million and a half square feet?

That's just a scale most of us can't comprehend.

Where are you on the life cycle of these things?

- So the building at Oakville is in construction, it will open in 2024.

The two big hospital campuses with multiple buildings will open in 2028.

So we're now in CDs on the big campuses, which will finish by the end of the year, and then the goal would be to start construction next year on both campuses, all things considered.

- [Ray] Wow.

Wow.

That's a lot of work.

There's a question?

Yes, Bill?

- [Bill] Real quick, was there a third-party project manager to help in the management that was a client?

- Let me repeat that.

Was there a third-party project manager involved with projects on that scale?

- No, there actually wasn't.

One of the things that's really been amazing about Inova's leadership, sorry, there's a fly buzzing around up here, was that the level of experienced individuals that they had in-house.

They have three project managers for each of these sites that just have amazing experience, have been in the construction industry, been at Inova for years.

Their leadership on the facility side has had significant experience in architectural and design, and they even made a really big commitment early on to bring a 20-year VP of nursing on to work full-time with this team.

It's their full-time job to work on these projects.

We talk every day.

They know everybody at Inova across all these health systems, and to be dedicated to bringing these projects to bear, work through all the user group meetings, all the challenges we know that happen, and so, no, there was no third-party project management, which is probably more unusual, but the significance of the experience they had in-house, this team, is really phenomenal.

- [Bill] Well, it almost sounds like a third-party, I mean, they brought in a nurse and dedicated staff.

- But all within the Inova family.

They were all there, yeah, yeah.

- Remarkable.

Other questions, comments?

Observations?

I would say the observation is the work was beautiful, and the presentation was terrific, nicely delivered, well done, and maybe in just the moments that remain, we can say a word of thanks to Ballinger.

Y'all have been supporters with HIAC for many, many years, faithfully so, and traveling the distance to join us in person every chance you got.

Thank you for that, Lou, for your continuing support.

Courtney, welcome to the gang.

Hope we'll be seeing more of you in the years to come.

Thanks so much.

Are there any closing questions or comments?

We're just about done.

- [Member] Who is the speaker next week?

- Who is our speaker next week?

Miss Cynthia.

Cue the music.

(snapping fingers) She's got these lists everywhere.

- [Lou] Well, for Courtney's first kind of professional speech, great job.

- Yes, indeed.

(crowd applauds) (upbeat music) (upbeat music)