- Howdy.

- [Audience] Howdy.

- Welcome to another lecture series here in KAMU Studio.

And first I would like to introduce you to our Dr. Kirk Hamilton, he's the Julie and Craig Veal Endowed Professor of Health Facility Design at Texas A&M University where he has taught healthcare design at the graduate level since 2004.

A fellow of the American Institute of Architects, he's board certified by the American College of Healthcare Architects, with 30 years of active practice prior to joining Texas A&M.

He's only the second architect advanced to fellowship in the American College of Critical Care Medicine.

He's also a frequent author and presenter.

So I would like to invite Dr. Kirk Hamilton up on the stage.

Thank you.

- Thank you.

Welcome everybody.

Those of you who are watching on Zoom as well as those who are here in the audience, we are pleased to have the next version of the health design Friday lecture series.

We are privileged today to have really two excellent guests.

They both represent EYP, an organization that has a national practice in a variety of areas, and Anthony Hass, who is also a fellow of the AIA, and the American College of Healthcare Architects.

He's the regional health care leader and senior principle for EYP based out of their Houston office and Jessica Petro, ASLA, is the lead designer in landscape architect out of the Denver office of EYP.

So Anthony has had more than 30 years of work in the healthcare arena, doing a variety of quite large projects nationally and internationally.

He is known for medical design and planning.

He's earned a national reputation, achieving improved alignment between evolving operational demands and architectural outcomes.

And we are delighted to have with us in addition, Jessica has a 20 year career in landscape working with a variety of industries, including the health arena and collaborates with the architects and others at EYP.

She received her BS in landscape architecture from the University of Connecticut, and she is a member of the American Society of Landscape Architects.

Anthony on the other hand has both his BEd and his MArch from right here in College Station.

So with that, welcome Anthony and Jessica.

- Thank you.

- Thanks, Kirk.

- Well, we're really excited to be here to talk to everyone and really to give an overview of really the passion that we have in the design world when it comes to collaboration and the process of facilitating the work that we live and breathe.

So today we hope to take you through an excerpt of examples of what we do and how we do it, and really just give you a preview of what it takes to work in teams and do some of the things that really we feel generate great outcomes and better understanding how people work.

The world that we live in is all about collaboration, and I think especially here in healthcare, even though our company is diverse and has several sectors, I get to spend my time in the healthcare arena and it's such a complex and detailed environment, but it all goes back to people.

And I'd like to start there.

You know, to me, the best part of what we do is collaborating with the folks that we get to meet.

The clinicians, the doctors, the nurses.

This is an example of one of the group sessions that we've had and we'll talk about it throughout the day, either how we've used these in different points of view.

But again, it's all about that collaboration and trying to get a consensus and understanding what is important to these individuals.

We were talking about it yesterday in our prep and Jessica said, well, you know, if you're designing a hospital and you have an emergency room in the surgery department, what, you know, in the experience, what is the difference maker?

And I think it's the people that we deal with and what makes it unique to those individuals and how they operate.

And that's key in the example that we're showing here to you.

This is just an excerpt of an old photo on the left and a newer photo, but the point of it is the progression that we've made in the world that we live in, and the expectations that the client and the consumer and the providers have.

Picture on the left is an infusion center, but it was in the day and age where, okay, we have this facility, we're going to build this room, we're going to put so many cubicles in it, we want to have it on glass, but it's overlooking a parking lot, as opposed to the picture on the right where we say, let's look at what this overall design feature is going to be, and what does it play out?

Does it have views to the outside, the orientation for the patients and I just think we really come a long way in the manner that we deal with the patients and how we provide a more humanistic environment for these folks.

- Yeah, I love the photo on the left.

The chairs are focused inward, right?

Because the view, it's not restorative to look out to a parking lot, right?

So they're turned internally, whereas the view on the right is how do we create those opportunities for engagement out into nature, as well as there's an elevated platform in the back so that people are receiving care or their experience still has unblocked views or connections into nature.

- Here's another example, but and frankly, with the landscape, the picture on the left really symbolizes where the facility is a project that was, I think, done in Bryan many years ago, but it was kind of a, we had an existing courtyard, so let's put some bushes in it.

Let's make it a landscape feature, as opposed to the picture on the right where we say, let's look at this rooftop and we're going to have so many thousand square feet, and I don't want to say that it's flamboyant, but its intent is much different than what we looked at and the importance of what it serves to those patients and staff members that go out on these root terraces and utilize these spaces.

I'd like to touch on this, Kirk, this may go back.

Actually, this goes back to Kirk's day and age, it's a project that he pioneered, a significant story in that the client bought 20 acres of a pine tree forest, a beautiful fight, but only 10% of the site was usable and not in the flood plane.

So Kirk provides a way to design a hospital in the middle of it.

But the point of what I want to talk about here is not so much for design of the hospital or the architecture, but we worked with a landscape architect.

They created some really nifty gardens throughout and around this facility.

And the day that I went and toured it with a client, which was several years after this was built, there was actually a wedding taking place in one of the gardens.

How many hospitals can you think of that hosts weddings?

And I think it symbolizes the creativity of a facility that is taking that stigma of what a hospital represents and creating an environment that's peaceful and enjoyable, tranquil, and so nice and delightful.

And I think that it attributes to the design, attributes to the idea, and attributes to society, to be able to utilize it and enjoy it in the community as a special place.

I wanted to touch on this here for a moment in that this diversity, equality, and inclusion is so much a part of what we do, even though it's in the lime light today, in everything we've always done as a practice.

We have so many different people that come from so many different experiences that are working as a part of our team from the design team, the engineering, all those clinicians, and again, we'll bring you examples throughout our presentation today that I hope gives you a good preview of what and how this works in the world that we live in.

I'd like to, you know, I think the fact that Jessica is here today is a tribute to this because adding landscape as a part of our team is so vital to what we do.

For most of our work over the years, we've always gone out and said, okay, let's bring on a consultant after we get through with schematic design and put a layer of landscape on it, as opposed to saying, let's look at how we include and make a team that thinks about what goes into news from the get go of a project.

And so I think it's wonderful to have someone as a part of our team, a part of our organization, to be able to deliver these complexities that we work with.

- Thanks.

So with going with healthcare and landscape, I wanted to talk a little bit about how I've seen the change or progression of landscape and its importance with health care over the years.

It's always been a component of the aesthetic of a campus, but now we're seeing it more of a part of the program and the narrative of a campus for health, healthcare, wellness, and things like that.

And one thing that I do actually like seeing is just the topic of mental health, wellbeing is more prevalent now and accepted.

There's like less of a stigma attached to people being transparent about having either anxieties or connections to nature and what that means, and what we're seeing is a lot of the conversation is about wellness and being able to put down the phone, put down our connections, and go outside, and be within nature.

I loved this article that was through Yale.

It was about a year and a half ago, but what it touched upon was just more of the science-based connection of healthcare and wellness.

The top example that I thought was really interesting is there's a practice in Washington DC, that actually prescribes nature as part of the healing process.

Going out to nature and experiencing it as well as also talking about forest bathing in Japan and how they'll go out and into nature, and aerosols emitted from the forest they see as being boosters in your immune system to fight off certain infections.

And so now they're doing studies about how can we incorporate that into the healing to set the right atmosphere?

So I love seeing that science is starting to look into more of that, and it's giving a different platform for landscape architects to talk about the importance of the landscapes within these healthcare systems.

So we put together the slides just to say that, you know, we're more connected to nature than we even think, right?

The patterns are within us and you see in nature and it's just something intuitively that we are tied to a larger system.

So some of these healthcare campuses are now thinking about how do we create a holistic experience, not only for patients and visitors, but even for our staff?

So that might be healing gardens within the landscape, you know, to breakout dining terraces, maybe smaller areas for respite, and meditation, or just larger areas that are for wellness and like maybe like a thrive walk and things like that.

So someone who has a break during their day can go out in this campus and experience nature.

So we've all walked through that parking lot on the left, I'm sure, right?

Trying to get away from that feeling, because you think about, I always say healthcare begins at the curb, because that arrival sequence from someone moving through that space, even before they get into the building, that experience can really transform how they feel once they are within the building.

So walking through this large asphalt parking lot, instead, what if we were able to work with the natural systems in the site?

Thinking about storm water management, you see the image on the right, that planting is actually a bio swale.

There's a flush curb, and then those stones, so instead of sheet throwing the water into a catch basin and like piping it off or downhill somewhere, why don't we look at infiltration where the water sits and think about the user experience of moving through that parking lot to a front door, it's completely different than the image on the left.

So our landscapes are dynamic and that's actually something that's great to experience and enhance, you know, with seasonal experience and just those connections of date, time, and light levels, as well as the image on the bottom right, that's from a campus down in Florida that we did where there's a wellness walk, so maybe you're not even receiving care yet, but yet you're on the campus and you're experiencing these positive elements of nature, so when you do need to go to the hospital, it breaks down that apprehension because you're familiar with it.

And it already has like a positive relationship.

- Okay.

Let's shift gears a little bit.

I'd like to talk about the evolution of our practice and what we do and how we work.

We'll take you through several slides and several experiences.

I don't know if this is a good picture, and it probably predates, I do remember going through a doctor at an early age and seeing a black bag.

I do not recall a doctor coming to my bedside, but I was told that at one point in time care happened that everyone's home, and, you know, the doctors made house calls.

I think that in many ways, this evolution is occurring to us today, especially with the effects of COVID.

And if we go to the next slide, when I think of healthcare in the early years, it seemed like complexes were built and facilities were set in place to sequester and contain and gather illness.

And this is just an example of a facility that is out and it's remote and all, and it's easy to say, okay, yeah, but who knows what built up around it and all, but what my point is, you think about it and then you go to this and you know, these urban centers and these facilities that we're working on now are just right in the heart of metropolitan cities.

These are super towers, super structures with thousands of beds and all the complexities and you think of individuals coming and trying to access this, and I think the point is we're trying to deinstitutionalize these, which by the same token, you look at it and you say, you know, it's a beautiful building, it's a nice structure, and all that type of thing, but what are those complexities that society's having to deal with?

And then you pin us up for two years with this COVID situation and pandemic, and you just have to question, are we going back to healthcare at the home and you know, or is everyone going to demand the hospital of the future being your home?

And this really just depicts, okay.

A physician coming over, I will tell you I had surgery last summer and I never felt more connected, knee surgery, to my physician and the clinical staff.

It was amazing.

I go, and I give them a credit card, and I get a thank you note, I get notices about all of it.

It was almost like they were watching every move that I made, and at the same time, people, you know, have taken great control.

Everyone's educated about their own health and wellness.

And so they want to be at ease, they want their family around them, they want to know everything there is, and I think if anything, the, and we'll talk about it here in a few minutes, about the infrastructure that has given tremendous access to clinicians and our services and our ability to know what's going on in and around us.

So I think it's important.

As a healthcare architect and designer, planner, this is a poor image, but the significance from the point I want to make, and all the real takeaway is health care to me is flexibility and adaptability.

This is a 80,000 square foot floor plate, and it's got 14 operating rooms.

We originally designed this to be an ambulatory care facility, and we're going to have moderate size operating rooms that were generic and treated for any kind of procedure, and in the end we said, no, wait a minute, let's go back, let's make them bigger, generic, standardize them, so they can be more flexible and adaptable in their use and all.

Ultimately, the facility went and said no, these are the best ORs we have, so we're going to do all our orthopedic care here, both inpatient and outpatient.

So that quickly changed, but again, it points to flexibility and adaptability.

The other thing is with structural or mechanical systems and the overall design is to accommodate, you know, MR and interventional activities to take place and swing in between these ORs.

again, it's that change in what we do.

This slide here just to pick a campus, and I think the point I'm trying to make is, I used to think of a project saying, okay, we've got this new effort, we're going to design this building, and you know, the budget is what it is.

And what I learned over the years is the bricks and mortar that make up one of these campuses is really about a third of it.

If you really look at the world that we live in, the next couple of pictures will really simplify the equation because the medical equipment that goes in and all those services that go in is so expensive by today's standards and new things are being generated on such a rapid basis that you can spend a small fortune on a project just with the equipment alone, and we find ourselves going through those adaptations on a daily basis for facilities.

And then the third part of that equation is the IT infrastructure.

This is the data center, but the point I'm trying to make is connectivity and tying all of these things together and being able to expand it.

And again, it's an international network that we're really working on.

And I think that the three of those, the bricks and mortar, the equipment, and the IT really sum up what makes a sum of a whole project.

I'd like to talk again, this is really more on what we've learned over time, and again, it goes back to the evolution, but the significance here is the little diagram on the left is a 36 bed unit, three neighborhoods, and we thought we had found really a significant, and we did, with this client, a way to bring patients and clinical staff closer to those patients.

So there's a, the blue dots signify a nursing station and where the clinical staff is in relation to the 12 beds within that neighborhood.

But the elevator, the orange block, is way on one end.

So access to that 36 bed on that far end became a real challenge by visitors and clinicians and things of that nature.

Excuse me.

Several years later, we had another client that liked the model, toured it, we came in, (coughs) and put a break in it, a public sector where we kind of split the difference and tried to learn from our design.

And then the third diagram, we split off, we finally learned our lesson completely, and we spit it so that we have public way in the middle, we had elevators, all that type of thing, but the point is our evidence-based design practice allowed us to study and research what we had done in the first place, what can we do better in the second, and what did can we evolve into and what can we achieve in the way we design what works in our building.

Now we want to talk a little bit about how we facilitate the process of stepping forward.

And we'll go to the first diagram, and COVID really has affected us.

We've talked about a process, sitting with the nurses and doctors, then I can't tell you how wonderful the experience is, best thing I get to do, (coughs) but through all of this, what it forced us to do is have maybe smaller groups where we have a camera over the table, and yet the other 20 people that normally would be sitting in the room are connected via computer.

So we've gone virtual, but again, that hands on communication, talking with the people have been so key and instrumental in our process and the way we work.

- And to add to that, I want to give like a perspective of a consultant working for, you know, the lead being an architectural lead.

So I've worked, in a couple of different ways, in the sense that I worked for a single disciplinary firm and I was a consultant to many different architectural firms, and then in my past two, including EYP, now I'm an in-house consultant.

And how does that change the dialogue and facilitation?

The architect is generally always the lead, right, when it's a building focused project, but I noticed over the years, depending on the team and how they work, it completely change the engagement and the result of the project.

So when I was thinking about today's presentation and about facilitation and the importance of what that means for teams, I wanted to take a moment just to talk about you being the lead, right, of a project and what that means for those subtleties of the different dynamics of teams.

So if you have an outside consultant, they might not even come into the process until a little bit later.

So how do you integrate them so they don't feel like they're catching up or their voice still matters?

It's all those subtleties of being that facilitator in group dynamics to be really like in tune to.

So you know that you have the best product for the client and that everyone does have that voice throughout the process, so.

- Okay.

Some of the tools we use here, this used to be a day where we would come and drop a floor plan down and think that everybody knew what was going on.

What we learned eventually was that half the people in the room couldn't read a floor plan and standards have changed.

Just like everybody else, everyone's gotten smarter.

Everybody wants to see what it's gonna look like when it's finished, before they even pick up or say what they want.

They want to see it.

They want a 3D model.

So these are some of the tools.

The picture on the left is, you know, the clinical staff or surgical staff working with little scale models from all the equipment in the operating room and moving it around to kind of test it and live by example.

It's gone so far and really helping them have conversations between themselves, and no, it doesn't go here, it goes here, or maybe we try this.

So it's been, not only does it help us, but it helps them communicate with themselves.

In the middle, this picture is an example of design dialogue, and what we do is give our clients or users a series of words, you know, it can be anything, any word, wow, architecture, front door, you know, finishes, landscape, whatever, and then a series of pictures that each individual picks up a picture of what that word and what that picture means to that word.

What's a wow picture?

What's the design feature?

What's the, you know, finished picture, that type of thing.

And it's gone a long way in helping us interpolate what is appropriate for the expectations of what this group is trying to achieve.

And it's been a phenomenal tool for us, and then finally the picture on the far right was really just a mock up.

It's a 3D model and it's, you know, a live cardboard wall where we put tape and things on, we simulate for gases and the fixtures and all the way outlets, and all that type of thing.

We bring furniture or build furniture.

We've always used mock-ups, but I can't tell you how beneficial and how vital and how useful.

Actually, in Copenhagen, where we were working on an international design competition, when we finished, they took an actual space and built patient room, a live patient room, and for six months used it with live patients and staff and interviewed themselves every week to determine the benefits of that shape, configuration, all before we invested the time to build 660 of these, and it was just ingenious to see how they used it.

And they actually invited us to come in and talk to a patient.

So we could sit there with an 80 year old lady was saying, hey, I don't know why you put this window so damn big.

I can't see.

There's too much light.

But the point of it is it was a great way to test and learn things from them in a live situation.

Another key element that affects everything we do or, you know, the guidelines and policies that are in place, the regulations, the rules that govern healthcare design, and I can tell you that every state has their own guidelines that you meet with the state, and really these are set up as minimum guidelines and what we have again, in our best practice is that we are striving to what is appropriate as opposed to what's minimum or what's maximum, that type of thing.

We try to really look at what is key, and again, that mock-up is a great way to test it.

If a room needs to be 120, is it really 120 or do you want to have it somewhere other than that, because it allows you to flex or move or flex that room and things of that nature.

So I think that codes are key to allowing us to do what we do.

I'd like to tell you a little story.

This again goes back to Mr. Hamilton, but the figure on the left in front of the helicopter is Redd Duke.

He was the founder of the Lifeflight System in Houston.

Kirk was meeting with him and we were doing their new trauma center, and Kirk introduced me as his new medical planner and Redd stood up and said, he didn't even extend his hand, and he got up and walked out of the room and said, "I don't want to meet any more consultants.

You guys don't know the world that I live in."

And so Kirk and I wound up calling his office and getting on his calendar for labor day weekend from like four in the afternoon until two in the morning and were allowed to stand next to this guy in the trauma department while they were bringing in train wrecks and gunshots and all this kind of stuff.

And I can tell you, it was the most impressive thing I've ever seen.

As an architect, it was the most informative because it greatly influenced my perspective of how they work, what they did.

It was incredible.

But the point is the man didn't want to meet me, and after that, several hours within, he was my best friend.

But the point of it is that it was significant in influencing the way we work and how we do it.

So from now on, or since that point in time, I've always gone and walked through the 40 ORs or the ICUs or the venues or whatever, to really get a feel of what, how do you use these things?

Yes, they're common in every facility, but the way they work and used is completely, could be completely different.

So it was an amazing story and a delightful way to learn how to work with groups and better understand it.

- So it's continuing on about facilitation and really understanding our client's needs, and the pictures, excuse me, patients' needs.

This is another example with a previous firm.

This is up at Yale New Haven Health, and it's actually, it's a cancer treatment area, and what we created was infusion suites outside so that patients could have treatment outside.

So what you're seeing are those pergola structures, they're more residential using wood and more of like the teak for some of the seating areas, but it has like lush planting around it, feels more residential, and there's a dry stream bed that then connects to a water feature.

So the ideas of meeting their needs and then saying, how can we elevate this experience for the patient to have this amazing connection and literally be healing within the landscape?

Another example of this is a EYP's CCU, where this is an Allied Health Building, higher ed, but the students get to work with the public, and the public comes in for treatment.

So in the front of this image, you'll see a lawn.

It's actually a sloped lawn, but at a certain percentage, so they can use it for PT and bringing the patients outside and literally have their session within the landscape, which we think was a really interesting way to use the landscape.

- This is Fulton County Hospital and the significance.

It looks like an aircraft carrier to me.

When I toured it it, I didn't get obviously an aerial view like this, but it's a 300 bed behavioral health, mental health hospital.

All the patients are court appointed.

It's a secure facility, but I will tell you, It's a secure facility, but I will tell you, it has demystified what behavioral health was and what it can be.

And it's just a phenomenal healing place.

We'll show you a few examples, but again, the design and the way it works, it just feel so comfortable inside.

And it, again, it goes back to what I said earlier about demystifying what once was and what it can be and how can it be healing and how can it achieve greater success than what, you know, we may have done years ago.

- What I love about this image too, is you could see, we call them snowflakes, like the asterisk area on the plans.

Those are actually the housing or the bed area.

From the image that we saw before, it was this large, from where we were, right, that black and white of this large square.

When you think about those patient rooms, you just look into an internal courtyard, there's not a lot of variation or visual interest.

Whereas with this design, each patient has direct connection and views out to a landscape, and then because of the way they're oriented, each view is different.

So it's the subtleties of thinking about like light levels, the views out, you know, still creating a secure and safe environment, but still having those open visual areas, which is another element of security.

We'll show some images interior.

- You know, to me, this doesn't even feel like a hospital.

The fact that it's got natural white lighting almost all the public hallways or patient corridors.

The finishes or the picture on the right is really the main room, all of the nursing units and the patient rooms.

And anyway, it's just a comfortable, very nice and healing space.

And they are finding that the patients are demanding less medications, they're more cooperative, and less stressful and all, and you know, it'll be interesting to measure over time, and see the outcomes and what we can learn from this.

The picture on the far left is the front door and the significance there is that even though this is a secure, high-secure facility, the very front part, the lobby, this entry, the photo we share, is really a community center.

There's a 300 seat auditorium and it's open for public events all the time.

Visitors can come, they have a beautiful story about the history and culture of this facility.

So, I mean, it's just articulate and it's really in the heart of the community.

- I love that it's like breaking down the extension into the communities, right, of having facilities like this within different neighborhoods and opening it up to the community to share in that.

So I think it's a wonderful example.

As well as if I was a visitor coming to see a patient, a family member, I think that experience of coming into a space like that would make me feel so much better just with the whole, you know, arrival sequence and things like that.

On the right is an internal courtyard.

So you could see that it is definitely sparse in the sense that there's not a lot of planting, but when we think about understanding the patient and our client and what they need for those spaces, that does create a limited palette, which makes a lot of sense for that.

We'd want it to be open and visible, but then also give, there's some programming elements in the sense that there's active recreation, maybe it's like ball courts and things like that, as well as different on variations of seating for passive recreation.

So a little bit different, it's not a healthcare, but this is actually in our government sector.

This is an embassy in Oslo, Norway.

And what we wanted to transition from this behavioral health to this is just talking about the subtleties of landscape and design and how it's integrated and enhance the experience.

So you could see that the site works with the building in the sense that it kind of is nestled into a hillside, but even at the front entrance, all those sighted boulders are in lieu of bollards.

So it is an embassy, you know, there's security, that's important, but it's a beautiful balance of saying why don't we enhance the natural landscape and experience and still make it a secure site.

So completely different arrival sequence with this example.

As well as this is another example up in Maine, it's a P3 partnership, so public private partnership with a developer, and this is a mass timber project.

But what we loved about this is, you wouldn't think healthcare when you see it, right?

You see this really dynamic pedestrian first floor facade, it feels, you know, community focused, so it's just a different way of thinking about our clients, their needs, what they're designing to, and coming up with different solutions for them.

- I'd like to shift gears a little bit, and this is really more related to culture, and I'd like to touch on that for a moment because to me, culture weighs into everything we do.

This is a facility in Brighton, Colorado north of the airport, and we were designing it.

The first time we went out to this site, it was a huge wheat field.

We almost got stuck out there and burned the damn car up, but that's another story.

The significance was that the administrator pulled up aside as the design team and said, "folks, we aren't Denver.

We can't have a Denver hospital.

We have a farming community, and our people are really proud of their heritage and what they have out here, but we have to have a facility that represents what they stand for.

So the colors, the tone, the texture, the brick, the stone, the landscaping had to be something that was more native to that community .

And we really stressed how could we achieve a contemporary facility but still giving them what they needed?

And so I think this was a very good example, but it was a wake up call to recognize who are you really working for, and who are you providing for?

- So another example of that is, this is the University of Kentucky.

I'd worked with a past firm, our master plan for it, and then the first phase is the patient care facility, which you're seeing that double tower, the tower kind of in the front.

But one of the things early on that we had learned about was just the apprehension of healthcare and breaking down the feeling of needing care and maybe a fear of hospitals or things like that, because what was important to the client was that there was a contextual front arrival sequence of utilizing native plantings, native plantings and the native Kentucky landscapes.

So what you'll see here, there was that precedent image in the bottom middle.

So you see that beautiful like fog coming through, the layering of the hillside, and then the front grasses.

But what we did was we extracted that idea.

We utilize a very clean palette of just ornamental grasses, traditional limestone walls, and they all had the same elevation of the top of the wall, but then what we did was we curved and, you know, mounded the land up against it.

So you'd see this kind of rolling terrain when you came in.

So the whole idea of this campus was to just extract that and have it contextual to Kentucky.

- I'll just touch on this for a moment.

This was when we were working in Denmark and what was significant is the people were bilingual.

They learned English as a second language at age five.

They allowed us to do our work sessions, but you can tell in the conversation sometime when you were talking about Western architecture, new healthcare, new ideas their, that there was puzzled look and things, so we had to take a stop, let's take a moment, let's have a Danish moment, take a break, have a fruit on the table or bio break or whatever.

As we took that break, everybody busted into Danish.

They're all talking.

And so we give them 10 minutes, they come back and I say, "well, what did you say?

What did you just tell your partner?

What did you do tell the person next to you?"

And it was phenomenal.

It was the best way we could retrieve all this information of what really was important to them.

It was great to hear what we had to say, but to give them that moment, and I will tell you, after a year of going through all these workshops and these little Danish breaks and these little tools that we use throughout our process, I had some of the best friends, I could go through Copenhagen and see them walking somewhere, and they were like my best allies, because I took time to listen to them and they valued that.

So keep in mind, next time you're working on a project or donging something, take a little Danish moment or whatever, and it may go a long way to helping you achieve great success.

These are just some of the photos, and it's currently under construction, we're still working on it, but we're very excited about the opportunity to do some international work and really recognize what is important to them.

These are just some of the photographs, but we need to wrap up here pretty quickly, and I think we want to conclude with the fact that with all of what we said, the tools and all the things that we've talked about, listening is really the key.

And we just want to touch on a few examples here of some of the components of how important it is to do what we do.

- And with listening, it's really understanding, like we said, who are you really designing for?

So you see the image on the left, it's a children's hospital, vibrant colors, variation of, you know, seating opportunities, and just fun spaces for children to explore and feel like it's designed for them versus the image on the right is obviously not children-focused, but subtleties and even way-finding.

You could see the sign in the back, you know, you're on the third floor, it's just really understanding what's important to your client, and how do we achieve that for them?

- We've shown you numerous pictures of these groups, back of conversations we'd have, but the significance here is if you look at the picture closely, there are three people that are gravitating to the table and taking up all the air time.

And then there are six or eight people in the background that, in every user meeting, in the back office, if a CEO walks into a room, a lot of people back off.

And, you know, I think the key is trying to hear and listen to everyone that's in the room and give everybody air time or, you know, a way to weigh in in dialogue.

So again, it's significant, it's a challenge, but it's something that's very important to every project.

Really, this is just our contact information.

We again are very thankful.

We do have a real short video that we want to complete with and we were told that technically it would be best to run it at the very end.

And the point of this video is really to say, you need to listen to everyone.

So thank you and we'll run this quick video.

(cheerful, guitar music) - What a great video.

I think all of us need to be thinking about having more children do our post-occupancy evaluation.

(audience laughs) I want to say thank you to Jessica and Anthony.

We have just a few minutes left, and what I'd like to do is give a chance for two announcements, and then depending on how much time we still have, we'll have a couple of questions.

- Thank you.

Thank you.

Congratulations, Anthony and Jessica.

Next week we also have a landscape session with Bruce Dvorak, introduced by Jane Maddox who's got his PhD in public health and Chanam Lee, a faculty member.

The title is "Empathetic Design: Integrated & Collaborative Design for Healthy People & Environments."

Palomar Medical Center in Escondido, California, Southwest Fisheries Science Center in La Jolla, California.

So that looks to be also a very exciting presentation like we had today.

Congratulations on the delivery where you, it was a very relaxed one, Anthony and Jessica.

So let's turn it over to the students, - Thank you, Anthony.

Thank you, Jessica.

Thank you, EYP.

Thank you, George, for arranging all of this and we are out of time.

Thanks to all of you who are on Zoom and Connect, and thanks to everybody who's here in the studio.

We are grateful for the cooperation of our local PBS station, KAMU.

Thanks everybody.

(audience claps)