Howdy.

Welcome to the Architecture for Health Lecture Series.

Today we have HoK joining us.

We have Virginia Pankey, principal and behavioral health practice leader.

And Amine Khemakhem, senior principal and director of health care.

Joining us.

Virginia is a recognized leader in programing and planning of health care facilities.

She is also a member of the Health Guideline Revision Committee and GRC for the 2022 FTE cycle.

Her specialties include behavioral health design for design, medical equipment planning and coordination, and energy.

He's based in Los Angeles, and he brings over 20 years of professional experience in leading large scale of healthcare design projects abroad.

And he leads strategic initiatives for education Health Group and also promotes innovative design solutions and assembles and manages project teams tailored to client needs.

So please help me welcome Amine and Virginia to the podium.

Thanks for the intro.

So we'll try to do this in about 25 minutes.

So what we're going to focus on today a little bit is, in other words, the what you can read.

There's no sites for this.

There's no one size fits all.

So we're going to talk about how we tailor design to the client needs to the users.

And really that's the important part.

And we're going to dive deep into the impact unit.

We have a and we'll talk about what that means versus, thank you.

But second, thank you.

I think I was going to start with this, but, you know, so we're really went through introductions.

So I'll talk about quickly the, objectives.

I will touch on different lines of, of the human experience.

And then we'll dive deeper into the impact unit.

And, what are we doing?

As it should pay to influence the industry and how our partnerships with different industry partners are actually moving the needle.

And we're hoping that all of us, as architects, we do the same thing, continue to move forward.

Let's do, we'll talk about the evidence based design, on how you improve the patient experience, the, care provider experience.

We're not going to talk only about patients today.

We're going to talk about everybody that uses.

You know, all the deeper into that and what that means, how does that affect the outcomes of a hospital or a system?

And then we'll get into a little bit of the safety, the protocols, and kind of going to the, impact unit a little bit more.

And then we'll bring it back.

So, yeah.

So, it's estimated about 12 to 15% of DV visits a year are actually real population.

So that's about $13 million a year in the US.

So that's why we, I mean, obviously Virginia specializes in behavioral health.

So that's kind of how come back from the, the, of the reason why that came about.

To really distinguish those patients and make sure we cater for their needs specifically.

So that's kind of why we're going to look into empathy units today.

But I want to start with the experience journey.

And this is a lot of what we do.

So as we've talked about, it's not A11 size fits all.

We think about who is are our real past.

At the end of the day, patients that are kind of come in for a period of time and then leave.

But then, you know, the care providers every single day and extremely stressed about the stressful environments.

You have, all the support services, you have, the, you know, the doctors and nurses will have so as we engage with different points of different projects, this journey map for the different uses, different for every single call.

Because we're talking about a different population, we're addressing different populations every single time.

So we mapped the joining us for the different users, what have you and the happy moment that followed the magical moment.

It's when those journeys cross, when those journeys overlap and come together, because that's where the magic happens.

Those spaces become really to facilitate spaces for respite spaces for people to care providers.

The there's the interaction that happens on a different level, more of a human level versus a care provider and a patient.

So we try to think about a hospital environment more than a place where you're going to get fixed.

It's not a it's not a secure department.

It's a hospital.

And so this helps us to look at the specificity for each of these users and tailor organizations to address their needs.

So the building becomes part of the human journey versus something that just causes a place to be treated.

Yeah, it's the environment is absolutely factor in in the healing of individuals and I think in the wellbeing of the staff members.

Also.

So you're looking at the worth of it.

And obviously the journey starts with before you get to this phase of the journey starts when you're first you leave your house, you're get out in the car, you're coming into the campus, you're going to have to find your way to the parking part, find your way to the entrance or the drop off immediately or what have you.

And then what goes on after that.

So it's not about just figuring out the operational part of the hospital.

It's figuring out the entire journey for the patients, for the users, for the care providers.

We use the word the heal the healers.

So we all know not only human patients but we also have to heal.

So thinking about the entire journey also means that you have to think of all disciplines.

How is every discipline affecting that journey and making it better?

From from a urban planning perspective, from a wayfinding perspective, interior design, you name it, it keeps on on.

Every single discipline has a piece of it.

So the integration of the team becomes extremely important to continue to drive up that given space.

I think that, no matter anybody coming to a health care environment can be so stressful.

I think the, the one thing when people have babies, they're always happy to go to the hospital, but otherwise, you know, you're going to find something else that can be very life changing.

And that's for the for the family members, the patients.

And it also does affect the caregivers.

And so to have places of, of spiritual healing and, and nature outside the door where somebody can take a breath and process the news that they've received is so important.

So we think about.

So we think about, you think about the staff, what are they means or access to access to medications, respite spaces.

The staff are in an extremely stressed environment.

Yes.

The patients are stressed.

They're they're sick.

They need to be treated.

But think about the stuff they they're to treat the patients.

So they might be there also sometimes to deliver some unpleasant news.

But you know what they're going to do.

Something happens or they're going to turn around in that second and be off for the next patient.

Put a smile on their face is an extremely stressful environment, so that it's up to us to provide the spaces that not only can help them to deliver the care, but also reduce the stress and give them the rest what they need and give them the energy they need to continue, every day.

So we we look at it as you think about the healthcare needs are, they need to be next to their loved ones, but they also need to be informed that need to be educated.

To provide them with spaces to also break away from their point of view, or be there for locals and help them to be able to navigate this.

The space that we find is much more than just signage, but having architectural and interior design elements that help them find their way when they're under a stressful period.

I don't want me to.

The patients, obviously the patients are there to get treated, but we also want to give them a space that is there for the the treat of the multidisciplinary, space for the lungs, for the those teams to come together, making sure they're comfortable, making sure that the space is lower, their anxiety versus higher height and very exciting, giving them options depending on their own needs.

And every patient is a little bit different.

And this is what we're going to dive into a little bit more.

Even when you look at patient populations in every patient population, there's there's so much that so we've talked about a lot of the flexibility of our spaces to to cater to all these different.

So we do a lot of surveys of our patient populations.

The number one is they want somebody to understand their and make sure they can connect people.

That's the highest need that we have.

And then it keeps on going, go through it.

But it's a lot of feelings.

There's the treatment but there's a lot of people don't feel cared for and feel treated in a certain way.

I want somebody to help manage my emotions.

So then we look at how is that affected our designs, and how do we come in as a model to this disciplinary team to help deliver some of that?

And, and I think it's so important to think about how important it is for us to listen to the, the end users.

And that means to caregivers, to the staff.

And sometimes we don't even realize that we have an implicit bias about how you might want to be treated in that space, but you need to listen to how the people that respond to really be there on how they feel about that space.

That's especially important in mental well, it's on the screen, but doesn't anybody know what impact it's okay.

So I don't have to explain the difference between empathy.

And that's like, you know, everybody understands that.

I think that's question maybe.

Yes.

Okay.

So a number of units, it's emergency psychiatric assessment and treatment and healing unit.

It is very different than it looks like.

You know, it's like, you know, it's pure like infection.

And you could be treated and that's like for, for, medical, needs and for.

Yeah.

The 10th unit is designed to be a short stay.

It's a place for a year and come in usually, ideally under 24 hours.

Yes, yes.

But the idea is you basically treat us into this unit.

You're you're given the space, addresses your needs, and then hopefully discharge before the end of the day does not, result in an admission rate for the inpatient.

Any questions about that before it's going?

So what we find is not only are the numbers of.

So based on the numbers of of people experiencing mental illness 1 in 5.

And that can be anything from anxiety, which probably every college student has, all the way to some severe mental illness like schizophrenia or, or bipolar.

But I don't know that a lot of people recognize that when you have a psychiatric illness, that you are likely to die 15 or 20 years earlier than your counterparts.

And that part of that part of the reason is it's a difficult to manage manage your health.

It is the disease that most often people stop taking their medication because it doesn't feel well.

And as you see on the slide, the likelihood that you are going to slow and have have diabetes is increased, which it actually affects how long you would live.

Right.

So that's why it's so important to treat the whole the whole person.

Again, we're talking about a patient to present themselves in the hospital.

A lot of times the they have, mental health issues.

So they're suffering from a mental health condition.

But a lot of times they're two separate from something else.

So how do we go about that patient population that have special needs because they don't want the population to come straight.

So the amount of violence in the health care you can see from this graph, there's more violence in health care than compared to all other industries combined.

And a lot of, a lot of those are to front to frontline workers, and can happen in, in the Ed or even in the inpatient unit.

And this just doesn't mean patients with mental health issues.

It may be a family member whose child is suffering and we haven't got our medication.

And the frontline workers really take the brunt of that.

And it really affects, how long a staff member will stay in their position for.

This becomes very important because as a matter of everybody gets in space.

So, it's not only it's the patient is the family member or it's the care provider.

So making sure that all of our solutions from a planning perspective, from an interior design perspective, from a furniture perspective, have to follow the, Drummond to the same.

Yes, yes, to make sure that we ensure the safety of the company, from what we need to provide.

Right.

So I'm just going to take a moment to talk about a kind of a patient story and what the difference is of your psychiatric patient versus, a medicine patient.

Patient.

So, if you go in to be treated for a psychiatric condition, but let's say you're, you're an eating disorder patient.

We'll show up.

We'll show a picture that that talks about the furnishings and the standard med search room versus, psychiatric rooms.

And the psychiatric bed is is a platform that which some of you may have, may have seen.

So if somebody with eating disorder needs to get an IEP or just different, pretty typical checks for blood pressure and whatnot, it is not convenient for the staff or really for the for the patient at all.

And so if you have if you have a patient that is suffering with both conditions, sometimes if it's a if it's a minor procedure that you can do in the room and they're in a psychiatric bed, they would have to be discharged from that psychiatric unit and, and then placed into the queue to go into the, into the medicine unit.

So there's a lot of duplicate duplicate work.

And inefficiency in that.

And also as a patient really, not a healing process.

So, I'm also on the GRC for the 2026 cycle.

We're going to have some, some code for the med psych units.

And this talks about we looked at what's in, in the behavioral health unit.

What's in that search unit, and what are the things that are consistent across those the patient rooms and the support rooms and in, in the med psych unit, we're bringing things that are typically in the psychiatric format, med search different from the medicine department that, you know, you don't have.

So group therapy rooms and a milieu area.

So there's a common area.

You can't just assume that because somebody is in the hospital that they are bad.

So as we talked about practice, we're going to do I'm going to talk about a couple of different projects that we did.

So this is an empath unit.

It was built in 2018, very early.

A doctor at the University of Iowa was on the seventh floor of a tower adjacent to the emergency department.

So there was lots of travel in between those departments.

So, we worked on the project that go on, what they found with that, with that department is that they had reduction in, length of stays, reduction of people coming back again.

And it really, made a huge difference in the lives, not only the people that were suffering from mental illnesses that needed to be helped in crisis, but we also made the flow within the emergency department.

If you want to go to the, things go a lot faster.

And so what they also found was they previously used to just be, well, we're looking for an inpatient bed.

Well, if you went in and you were having an asthma attack and they said, well, we'll we'll have you wait here until we find you an inpatient bed and an asthma hospital.

That's not going to go very well for you.

So, that's that's why Doctor Zeller came up with the model of the Empath unit.

And so by having a special area for these patients, it allowed processing in the emergency department for people with medical issues to be processed faster.

Also.

So 80% reduction in admission rate.

So it really makes a huge difference.

So I really think this emphasizes the reality of environment matters.

And having data like this, I'm going to spin it a little bit differently here from from a system perspective or from hospitals, which would have a data lake.

This is extremely important to us because at the end of the day, we're also stewards of the money for our clients, right.

So we want to make sure our clients are invested in the right place for their, optimizing their efficiency, their operational efficiency, and they really invest in whether you're going to make a difference for their communities.

So if you think about this, if we through this model, the research has shown that you can actually, be a lot more efficient and save quite a bit of money and resources the bigger part is the resources.

One of the most painful things right now for our clients is, attraction retention in tough and making sure you have the right number of nurses, the right nurses, right number of nurses to have happen.

So being able to offload, and be a lot more efficient, it helps our clients financially and from a business we don't have investment and making sure they're invested in this.

So if, if the patient population has a need as, say, in cardiac beds, but they have an issue that if you resolve it this way, they can reassign those funds to make sure they requested the right thing to address the patient population and community needs.

So, University of Iowa saw this, saw this.

In fact, this is a plan of those the lines in in gray, are their existing emergency department.

And so, renovated the area on the top of the plan for pediatric, and we added a behavioral health emergency department.

And so this is a plan or of the pediatric department, if you push one more slide, it'll show you where those p p behavioral health rooms are.

So these are rooms so that younger, younger children who are having behavioral health issues can be treated.

But it's a flexible room.

So so that you can use them for for patients without mental health issues.

And then we go into the other side of the plan.

And this is it started out that they wanted all these rooms to be strictly for behavioral health because they're at their trauma one hospital, and they draw from, the rural areas in Iowa, not just from Iowa City.

And so they ultimately recognized and also this is speaking to the health care system and using their resources wisely, that if there's really just some some big event that these rooms, individual rooms are, are acting as flexible rooms too, so that the state and medical gases and items that, psych patient could harm themselves or use as a weapon toward somebody can, can be closed off.

So they can serve both those, those functions.

We also have the reality of there was more imaging that was needed.

So there's an MRI at the end that is not accessible from within this unit, but it's adjacent to.

And so there's an entry and and and and two entries at this unit.

So you can get to it from both ways on this.

And there's the triage and intake which is adjacent to the existing triage area.

So that so that there are special behavioral health rooms that can be utilized.

But if there's at the time more standard patients, you can utilize that on subsequent.

And so this is this the second floor.

So this is the impact unit.

And they were while the adult unit was very successful, they were having a high number of adolescents with mental health issues that would benefit, they felt would benefit from an impact unit.

So this new unit we designed has an adult side, and then it has the the nursing and support services in the in the center area and the adolescent on the other side.

So Virginia has a patient, presumptive staff that they determined to be transferred to the psychiatric unit next door.

How is then is, determined that the patient needs to go up to the second floor to be in the what determines the project?

So I think is is they come in through the intake.

Maybe maybe someone is highly agitated.

It's it's hard to maybe understand what their needs are at that time so they can place them on the, on the first floor and be be reviewing them.

Or they can maybe be waiting for some medical testing, because sometimes a physical illness presents as something that is a mental health issue.

But that's really not not might not be the case.

It might be somebody with a urinary tract infection, and they need to wait for that evaluation before they can take them up to the impact unit and, and allow someone to calm down and be properly assessed.

Right.

So these are some of the some of the photos from that process in the, in the pediatric department.

I actually saw one of the project managers at a conference recently, and he was very excited to see me and said, how impactful was this project was?

It made a great difference in the the flow of their emergency department.

So this is the adult.

This is the adult side.

And that's a different view of the of the adult side.

So they had some lockers within the room with their personal belongings.

And they have TVs that are monitors that are safe and they have clear story windows so they can get outside, like, their view would have been to the roof top of the TV.

So that was it would be very pleasant, but it really made a difference.

And then there's going to have a unit that has access to an outdoor space that's full of, different views of the different patients.

So, this is obviously an early one, by the way, the two different ladder chairs, but it's not quite by choice.

It was, they had sort of the requirements where they, in the system, so many of them, but picking the colors, picking the graphics again, the, the, the furniture was very carefully studied to make sure it addresses.

Then we'll come back later to talk about how the industry reacts to all of these decisions.

That and so we talked we talked about those elements.

And so this is the care station.

So they have a good view.

Oh we only have a few minutes left.

So quickly through.

So this is Saint Joseph.

And since, talk to you at the bedside, but this, this this area is really actually an old, there's the two kinds of bed, that surge and platform.

And this was a unit was a 30, 30 bed med surge unit.

They were having clogs on their, emergency department and needed to kind of extend their, emergency department and moved part of the intake.

Intake will get to that.

The blue beds are the medically enhanced beds they call them.

And then we have the standard, standard, behavioral behavioral health that.

So we also we look at the, safety risk.

The red is the highest risk where a patient is is alone and and prone to, to self-harm.

Green is where the, is only like staff on staff members like this.

So this is the, this actually, they chose this system to do a psych med unit.

So it's it's, run really by the psychiatric staff.

Staff.

And they have medicine, support to to help, but they bring those patients up to this unit, and it's kind of an empath unit, an intake unit at the beginning.

And they might just go without ever being, admitted as an inpatient.

So again, this is a pretty unique situation.

So if you look at the two examples they're starkly different.

Yet they the things that come from the same unit, but they're very differently designed to service certain properties.

And there's yeah, trying to trying to solve the same problem.

You said Saint Joseph, you see Saint Joseph's Hospital.

No, no.

This is Baycare in, what's Florida let's it.

I'm sorry, friends, but.

And there's some of that patient unit support that is very different.

Okay.

They've really had reduced length of stay again with this unit and also so it's, it's very beneficial, to have this and less, less admissions.

I think that's.

Yeah.

Just a couple more times.

This is, just words that were talked a lot about was outdoor spaces.

We want to live with this too much, but we want to show you an example of what that might look like.

And we're behind with the know some of that roof is in another space.

But those that we have different outdoor spaces that serve the patients and some of them serve the people and stuff like the rest of the space, because you can cross and, and back, this is actually the one upstairs that won't do.

And so we can we tell that your slides, we have one more.

Okay.

All right.

We'll slow moving.

So great.

Great.

So, as Roxanne said, we, I'm on the FGA committee.

HRC and I had the behavioral mental health topic group.

So across all inpatient, outpatient and, residential guidelines that's affected.

And we work with people from within the clinical industry who are also creating guidelines for, for the mid med psych unit.

So we presented with them and had workshops with them so that we're really helping each other and learning from each other.

There's just some contact information for, for that.

I, I also presented in conjunction with, with one of the leading physicians, Doctor Wittig, on this topic and then the empath units.

We we work closely with Doctor Zeller.

He's also a member of the GRC at this point.

And and so I've we've really learned a lot about that.

It's not in my mind.

It's not enough to just know about and learn about the design.

You have to learn about the clinical things that are happening and understanding what those things are.

We did a podcast with, with pineapple and I will touch on.

So I was the primary author and the topic for the Behavioral Health Crisis Unit, which is based on the impact model.

And then we talked about how that influenced the industry.

So those the the recliners in the Iowa project were more traditional health care recliners.

But since 22 and those new behavioral health crisis unit guidelines came about, we have like 4 or 5 vendors that come up with special recliners just for these units now.

So, this is a project concept group we're working on with Kings Way, which is a, a vendor within the, the health care space.

And we met with people with lived experience from Katy Blessing Center and worked with them to visioning and understand, what their what their needs are.

And it's really a voice that we believe needs to be brought to the table.

This is actually a research project that we did in house, but talks about the same thing.

Okay.

Yeah.

Here we try to get involved.

It's not about just the living.

It's getting involved with the entire industry to make a difference.

At the end of the day, we're trying to help somebody do their job better so they can save some lives.

Like little small moves, to the fact that there's four models now instead of one that could make enough difference to save somebody's life.

So we try to come at it with a lot of different angles, and not only this awesome exposure and this design, it, we also have a duty to do population to help our communities, to save lives.

And so those who are doing that every day, we just need to belong to the right spaces to do it.

And hopefully the idea is that our architecture, our building through the healing journey, and not just the space where we continue to change and continue to struggle to provide that care.

But I think it's I think of it, this purpose driven architecture, all of our nature really is.

Wonderful.

Thank you so much.

And I appreciate, that you address like a piece of the presentation, considering the limited time that we have, we've seen here some slides.

Well, we can have one question from students.

One short question.

But, anyone?

Okay.

Kathy.

All right, from your.

I think I've taken your, taken about your letters and, comfort.

Okay.

Okay.

Anger.

So for, one thing that stood out to me was the importance of communication between.

We have clinics in practice.

How often do you typically, communicate with them, how physicians.

Work the report.

So I can do so when we're working on a on a project schedule at the very beginning, we come up with the word plan.

And it's as we're designing the project, we, make sure that we meet with a lot of different groups, not just the nursing, but, materials management and the facility departments to make sure.

And we're really seeing all these voices, and we usually have a cadence of every, once every three weeks when we're working on the schematic design, we might have a a little pause to rewind.

Sometimes we have we have some pricing that comes into and then we meet on design development, which is, you know, where's the outlet, how deep is the cabinet?

What's that?

Medical equipment.

And we do that at a at a three week basis also.

And then as we work on the construction documents that's more heads down.

So we don't meet with them as much.

But we have like projects manager.

So if we need to to clarify, clarify something, we can we can do that.

So from the project inception, or as soon as we step forward to say somewhere in this meeting with the users and general, all the users, weather conditions or patients or the administration, it's what happens.

Initially we start with more of the needs of each of the disciplines until you get a good grasp of the organizations of the building, we get it to the department.

Then it becomes a heavy schedule, where you meet every problem multiple times, sort of stage.

You get to the previous part.

It's a lot of meetings, a lot of people, a lot of nodes.

The outcome of the, depending on the stage could be a little bit different.

Sometimes you still think you just were talking more about sizing.

And then you go all theoretical organizations and then you get into or the idea of what's going to be part of something else.

You actually have to do is in support of that.

And there's usually a champion for every single department.

And so that means as we as we develop things and sometimes let's say it's some kind of, integration of technology or the medical equipment that you can go back to that champion and say, we've had to make this adjustment.

We've we've listened and understood what your goals and your slogans were.

And so this is our proposed solution.

Does it still still meet your needs?

So one last thing.

We also have multiple trials because they meet the standards.

And then sometimes we combine them and sometimes they're separate times.

So all the disciplines also went back to that same sort of the disciplines have to come together.

So sometimes the logistics come and way again the clinicians, they're doing their job much, much more important than us.

And so we will have discussions.

So yeah, I've had meetings at 6:30 in the morning or 6:00 at night with surgeons.

Well, I'd like to, and it's okay for your time.

Excellent presentation.

Thank you.

Think, students take advantage?

I think there's several of them that are doing behavioral health.

But even if you're not doing it, I think you have one that has the it's for 8 million people have behavioral health programs.

So it's going to increase.

Yeah.

Also on a separate topic, I'd like to introduce, Lieutenant Colonel Thomas Garrido present.

He's in cognito.

He's retiring from the U.S.

Air Force.

He's an upcoming trust.

And he's also been, with the Navy.

Flying these observation planes.

And so he's had two military careers.

So welcome, Thomas.

And, I think everybody knows Wei Yan, who's our interim department head, so... and thank you, Roxana, for another two excellent speakers.

Absolutely.

Well, again, thank you so much for joining us.