- Welcome.

I'm Kirk Hamilton and I'm on the Faculty here at Texas A & M and I'm delighted to welcome our group of speakers today.

They represent the firm of EYP, it's based in Houston but, or their offices is based in Houston.

EYP is a national firm with offices around the country.

It's actually a firm the predecessor of which I was associated with so I'm particularly delighted to have the chance to introduce them.

We'll have three speakers today.

Mezio Zangirolami, who is a graduate of the University of Houston.

He is a licensed architect in Texas.

He's certified by NCRB, the accreditation group for architects and he is a Lead Designer, Senior Designer, and an Associate Principal of the firm.

So welcome Mezio.

Zhouzhou Su is one of my former students.

I'm delighted to have you come back.

She earned her masters and her PhD here at Texas A & M after her bachelor's degree in China.

She is a Medical Planner and a Senior Associate with the firm.

She's also registered architect in the State of Texas, and she is in CRB certified.

So welcome Zhouzhou, welcome back.

- [Zhouzhou] Thank you for having me.

- Another welcome back is gonna be our lead speaker.

Renee Fiala is going to open it up for their team.

She is also a graduate of Texas A & M. She had her BED here and a master's degree as well.

She is a Medical Planner, Project Medical Planner and she's Associate Principal of the firm registered architect in the State of Texas and she has the Evidence-Based Design Accreditation Certification certificate, so she is EDAC certified.

So it's with a great pleasure that I welcome you to today's conversation.

It's about Human-Centered Design and it's going to be about the big picture all the way down to the small details.

So Renee, over to you.

- Thank you so much Kirk, and always a pleasure to come back to Texas A & M and back to where, you know, it all started for me, but I wanted to share a little bit about EYP.

We are an integrative architecture firm.

We do engineering architecture, interior design, environmental graphics, as well as consulting work as well.

In terms of our work, we focus on kind of the more critical design typologies, including healthcare design, higher education science and technology, as well as government work and within healthcare, we do both pediatric and adult healthcare as well.

In terms of our office locations, as Kirk mentioned, we're from the Houston office, but our firm really spreads nationwide from Coast to Coast.

You can see the offices locations and in terms of our healthcare work, our firm, we have over 400 staff and about half of them are devoted specifically to healthcare architecture.

And within our projects, you know, most of our work is repeat clients and in each project, we are always trying to instill lean principles, as well as Evidence-Based Design, which again goes to our topic today of Human-Centered Design.

So agenda for today, we're gonna bring three different projects to you from the U.S, as well as abroad and a range of adult, as well as pediatric healthcare architecture.

- [Mezio] I get to do the pediatrics 'cause I have the fun socks and so- - Exactly.

(both speakers laugh) So I'm going to go ahead and start us out.

Looking abroad to the Bispebjerg Somatic Hospital which is in Copenhagen in Denmark, and it includes both adult and pediatric healthcare.

And this project was done in association with KHR architecture which is a Danish for a local firm in Denmark, as well as Arab.

in terms of the site context, the project is in, as I mentioned, Copenhagen Denmark, and in the health district city of Copenhagen.

and the site is actually 120 year old site with an existing hospital there.

So you can imagine the old architecture there, the design principles from 120 years ago, have evolved significantly over time.

And so, the new hospital is a replacement hospital for 600 beds and over 700,000 in gross square feet, so really big project as well.

But you know, this project, I think really, the site and the context of the area, a lot of low rise architecture, brick building, strong axes there, you know, really played a lot into the design of this replacement hospital.

- [Mezio] And I think this is something you see in Europe a lot too, is that you've got this, you know, you're steeped into the context of the area, right?

So whereas here there's a lot of space and a lot of Greenfield type sites.

So, you know, it's always fun and challenging to work in these types of situations.

- And something very interesting about, you know, just the design of it.

The codes in Denmark actually require natural light to be in all occupiable spaces, which is so different than the U.S here.

So really it lends itself to a more penetrated architectural design instead of these really thick diagnostic floor plates.

It's now, you know, you can see like penetrated with light to bring light down to the basement level, the ground level, and make sure that, occupants that are working in these spaces have that access and it's not, you know, where you're, kind of in an enclosed room for 12 hours of the day.

- And it's all occupied spaces, right?

- exactly.

- That doesn't include, like stuff, like that- - Storage, exactly .

- I think it's the same case in Asian projects that you will see patient, this, that long scheme, that have nurse station at end instead in the middle.

So I think European and Asian Haiti room design probably are quite similar in that.

- And we'll see the stark contrast of that in the later projects as we look.

But again, this is just, you know, really creating the diagnostic and treatment floors were really like sunk down kind of into the landscape here and then penetrated with courtyards and then really letting the, the patient floors stand proud above that platform and really matching, you know, the brick, the vernacular of that existing context.

- And I think, you know, it provides with some really wonderful sectional qualities when you start looking at it, especially as it kind of goes into these basement floors and it's something as architects and designers, we're always trying to see how you can improve, you know, outcomes through exposure to nature and things of that sort.

And it's maybe a little hard to get to this level of, you know, kind of infusion here in the states, but we try nonetheless.

And you'll see when, when Zhouzhou talks about Hackensack, how that affects the kind of these mega floors you were talking about here.

- So, this is again showing that wonderful sectional qualities of what this lends itself to.

I think, as architects, we really enjoy being able to design these multi-level spaces that bring in light.

And I think that was absolutely the opportunity here and the bed floor is really matching that brick, but then connecting with these really elements of light space that kind of fit into the background and allow visibility from one landscape space to another while respecting, again, going back to the architecture of the existing context there.

So, in terms of efficiency, you know, obviously we still want hospitals to be, you know, lean mean machines and, you know, obviously even in Denmark, they want it to be that way.

But I think because of some of the codes, you know, it doesn't, I think from a design side, when you start penetrating with light, it eventually, you know, it spreads out this hospital building.

And so really still trying to get that onstage, offstage concept where, you know, the supplies are then moved multi-levels, you know, maybe come in from the basement level and circulate to different pieces of the building and come up vertically to then service the different areas and allowing the public to really, you know, circulate more around that exterior space where you're not going down a corridor and seeing, you know, some carts or a stretcher come by as your, you know, first impression to the hospital.

- [Mezio] Yeah, I pointed Zhouzhou, 'cause she's gonna talk a little bit about that later , right?

(speaker giggles) - [Zhouzhou] Yeah.

I'm gonna talk a lot about lean design on offstage design.

- So something really interesting in Denmark, they're really excited about, you know, robotics and automated vehicles even within the hospital.

And so I think this was a fun piece of the project to kind of think about, but, you know, as the architecture lends itself to these more elongated spaces because of the light and the, for plates, you know, over there are using robotics to deliver supplies to the different departments.

And so, you know, it's more of, I guess, that a lean design in a way that you're not stockpiling supplies up on the patient floors, but when it runs out, you know, something is triggered and a robot then can send, you know, five more syringes up to the floor.

- More just in time type delivery.

- [Renee] Absolutely.

- I mean, it's also a way to really help the safety of, you know, the staff, I think because when you're pushing a lot of heavy materials through these long corridors and sometimes, you know, levels aren't the same.

And so you're going up ramps and so forth and there can be a lot of, you know, injuries that happen.

And I mean, you see that here in the U.S too with some of the supply chain, you know, staff that have the automated components to push these supplies down the halls, but you know, you've gotta store that stuff somewhere as well.

So, you can't think about- - Around.

- The whole thing.

And on that note, I think nurses, they walk a long distance on daily basis.

And I think if they can spend less time in hunting and gathering stuff, they can spend more time in direct patient care.

- [Renee] Absolutely.

- Yeah, and it's interesting.

I once had a, we were working on a project where we were looking at the direction that the stretcher would have to go into a room and they made me push a colleague.

Actually, they made the colleague push me because she was much smaller than me (Zhouzhou giggles) and on the stretcher to show that we really had think about making it a lean move and not have all these twists and turns because that can lead to injuries for the staff.

So I think, you know, all of this is kind of related in that sense.

- [Renee] Absolutely.

So in terms of the bed, you know, footprint, a lot of time was spent in the patient room.

I'll get to that in a minute, but you can see the orange spaces as the support .

Again, because of the robotics and because of the light really needing to penetrate every room.

A lot of the support spaces were, you know, down in the basement storage areas, you know, off of the unit.

And really it's just, as you said, the, just in time supplies on the unit.

So, much more minimal support per patient room in this kind of a design.

And the other thing was, you know, this project, they came from 120 year old hospital.

And in those days it was three or four patients per room.

You know, the private room concept was just not around at that point.

And so it was a major cultural shift to design something as private room here.

But in doing that, you know, we'll get to the design of the room in a little bit, but you know, it was much more like having the family there and that private room setting was much more achievable than in, you know, with three or four patients in a room.

Oftentimes the staff tells the patient, you know, the family, I'm sorry, you know, it's limited visiting hours, you need to go wait in the lobby, 'cause it's just too much in one room.

So they're really excited to see how the private room works out for them too.

So in terms of the room design, really, you know, I think oftentimes we're looking at kind of a two rooms with some nested toilets and, you know, looking to maximize the view into the room as well as the patient's view outside, but here really, I think it was much more focused on providing kind of the same experience to each room and really maximizing the patient's view to the exterior as well as the staff's view to the patient.

But they were much more focused on the staff zone, not interrupting that patient as they're healing or spending time with their family, you know, not mixing the pathways.

So a lot of the paths were studied and trying to provide the same room where, you know, the staff could work in a vestibule space, pull a curtain and not disturb what's happening in that patient room with their family as well.

So again, opening up those entries and a lot of, you know, the ergonomics of a patient can getting out of their bed and how do they make their way to the bathroom?

So it was studied in detail and came up with a design that the patient toilet is on the head wall of the patient bed.

So the patient has minimal steps to get to that toilet to reduce the chances for falls, reduce, you know, the challenges with staff, helping them in that distance.

So a lot of attention paid to that detail there.

- [Mezio] Yeah.

- And then in terms of the room, you know how it's divided, you can see a little bit better.

What was interesting here is something very different than what we're doing here in the U.S is providing natural ventilation opportunities to the patient room.

So, you know, although they didn't have a balcony, what ended up being designed is, you know, they had a door to the exterior that they could open and provide natural ventilation to help the healing of that patient.

And I think, you know, the focus of that is just, it's great benefit to the patient to get that breath of fresh air if you're in the hospital for a week at a time and never being able to go outside.

I would love to be able to open a door and- - It's funny you mention that 'cause I grew up Italian and I remember my mom would oftentimes just open everything up and say, we gotta air this out because you've been sick, you know?

And so whatever.

So it's sort of like a cultural thing, right?

It's like, get that air moving and now we're finding out through the pandemic, that's not necessarily a bad thing.

(Renee laughs) So get that air circulation going.

- Yeah.

- [Renee] Exactly.

- I think the same thing in channel when my mom first came over to the U.S, it's so shocking to her that we don't open windows when we're in the room.

Like why don't you open windows?

We need fresh air in the room.

I think the cultural difference is just so interesting.

- [Renee] Right.

So again, the separation of family zone, staff zone, and then they were really excited about the family taking an active role and caring for that patient.

You know, oftentimes it's your family that can give you the best care and see when you're starting to fade or you need attention.

The staff, you know, moving away from these rooms with multiple patients in the same room, going to private room, I think it brought them a lot of comfort knowing that a family could be there to be a second pair of eyes and caring for their patients.

- And that's, that's very similar in the pediatric world, right?

- Right.

- Because right kids need that support.

- So tying to the staff safety, I mean huge emphasis on staff safety, you know, they're making the, the financial investment to put a patient lift in every single patient room, which is a huge expense, but lends itself to, you know, safety for the staff.

They're not having to maneuver that patient and have chance of the patient falling or hurting the staff member.

And the other interesting thing is, you know, over there it's, let's get that patient up and moving.

They need to be healing.

If you're just laying in a bed, you're gonna feel more sick, but let's get them up and get them as vertical as we can as often as we can.

So they wanted the lift to go almost everywhere inside of that patient room, not only to the toilet as we would provide in the U.S, but all over the room so that they could really spend majority of their time outside of that patient bed.

In another investment here, was looking at the ergonomics of the toilet fixtures and the laboratory in the bathroom.

And, you know, sometimes you get a patient that's really tall and to bend down to the toilet, that's a long way.

And they looked at this opportunity where you can have actually an automated fixture move up and down to meet the height levels and the differences of each patient.

To, again, impact the patient safety and less chances of falling or, you know, just more comfort as they go to the fixture.

So again, the laboratory to wash your hands, if you're taller, you can just click a button and it raises it up.

These are very, it's expensive investments- - Pretty, so that's really interesting.

- That's again, a Testament to their really, you know, focusing on the ergonomics of not only the staff, but also the patients.

- So as we think about the Human-Centered Design aspect of this, you know, designing empathically is a perfect example.

You know, how can you, even these little details like these fixtures being able to move, yes, it's an investment, but it's one that they're willing to make in order to kind of design around the person or the patient population they're serving.

- Exactly.

And then another interesting thing is, you know, I think there was a lot of hesitation about private rooms.

So they made the investment to go and actually build a mockup, but not just a mockup, an actual patient room in some of their shell space in the hospital.

So they had, you know, a window and they were able to build the actual walls of the designed room, bring in electrical services, medical gases, and all of the final finishes that they're planning for this room.

And then actually put real patients in the room.

So they've been doing that now for two or three years, testing the room and when something doesn't work, they rip it out and they move it over three inches.

If that sinks not in the right spot, okay, well, let's get it where it needs to be and make sure that works, you know, before building 600 rooms wanna make sure that they had it exactly right.

So spent a lot of time around all of the details of the room, and I think, you know, they'll end up with a product that they are very comfortable with the end.

So with that, a couple of shots of what it, you know, bringing that break into the patient floors.

and again, penetrating that light all the way down to the basement, down to the emergency department, you know, still, although you're in a garage and, you know, you're trying to find your way having these Wells of light, you know, I think help a improve that experience down there and orient you, you know, as well in terms of the project duration, you know, it started, it was awarded in 2015 and they're not expecting the project to get the first patient until 2025.

So that's a 10 year window which I think is much longer than what we see.

You know, obviously hospitals take a lot of time, but I think here the investment in a lot of these principles and figuring out how it worked before it gets built, was a big investment for them.

- Okay, thank you, Renee.

So now we've seen a great example, a demo project that strongly emphasize in natural view, natural ventilation.

So now we're gonna talk about a typical U.S adult hospital.

Maybe we can tell the differences and similarities between the two.

So this is a project in Hackensack, New Jersey, new Hackensack is to the north of New York.

So you can see if you stand on the south side of the campus, if you're standing high enough, you can actually see the new York's skyline down south.

And this hospital is nonprofit teaching and research hospital, and it has a little bit less than 800 bed in the campus.

And it sees a large amount of inpatient yearly.

And on this campus, it also have other buildings like cancers, children's, women's and heart and vascular.

So outside is right here, in the middle is the yellow box in the middle and there's a street underneath the yellow box.

It's called the second street.

So this is such a unique side where the project expands over a street, connects to the garage down south.

- So it's interesting 'cause this is a much more urban context, - Correct.

- So it presents its own challenges.

- Absolutely.

- So it's not as much of about the historic context, but how do you make all these buildings function together, even though they're quite different from each other, right?

- And on top of spanning over a street, this side is a slope side.

So to the left of the page, this is the rest of the campus and to the right of the building, that there is a hospital garage.

So the building is sitting in the middle over a street.

So the main public concourse is actually on level one, so connect to the rest of the campus.

But if you are on the street, on the second street, it's actually four fourths up.

So, and then it connects to your top floor of the garage, which is the fifth floor.

So this is very challenging.

So when I was doing the planning of this project, I was thinking, okay, if I'm taking my mom to this hospital, I'm gonna drop her off, on second street, and I need to turn around and go to the parking garage.

I hope there is a good signage to tell me I need to go to top floor and find a Skybridge, go back to the house floor and my mom is three floors down the below, so just by doing that kind of mental simulation, I think it helps me as a planner to design the place and also help with the way finding design.

- And I think like if we think about that light well into the garage, if you had some kind of, you know, orienting element as you, 'cause you go into a garage, you kind of get turned around, right.

I mean, that's one of the tough parts about entering a building through a garage.

And so if there was a way to kind of bring in that to the experience, and obviously you have to balance that with, you know, budget and constraints of the site, but you know, always try to look for those opportunities I think because- - Right, absolutely.

- The only help that improve that experience.

- Absolutely.

- And the last project was really like nestling down into the ground.

And this one is, you know, lifting a lot of it up above over the street and similar challenges Like if I'm under this big, you know, massive footprint, then how do I know where I am?

It's gonna be so dark under there.

Like what kind of lighting is there?

You know, how do I figure out where I'm going and how do we make it a celebration of architecture, even though it's so dark.

You know, how do we make it a good experience still?

- Well said, yes.

So in terms of collaboration, I think each hospital is different.

So on the left of the screen here, so these are the hospital leadership that were involved in the design process.

So on the right hand side, we have frontline staff and we have good representative from all disciplines.

And we spend over a thousand hours meeting with them, just understand how their hospital is working.

What's their flow, what's their preference.

So it's very crucial to get the voice out of everyone in this hospital.

- And I think that's, again, that's Human-Centered Design, right?

Hearing the different perspectives and voices and understanding how they need to integrate into the design.

Without them you end up with something that, you know, isn't gonna work.

Right?

- Right.

- So lean design was implemented throughout the design process.

So we show two lean techniques here, on the left screen here.

I know this is very detailed and it's very hard to read, but I'm gonna explain it to you.

(Mezio giggles) This is what we call is value stream mapping.

So what we're trying to do is just map how the path of the equipment, starting from when it arrives at hospital.

So it got uploaded from the truck, it arrives at the dock, maybe it got transported to the warehouse, maybe it got transported to other places in the hospital, but eventually it will be in the operating room, right?

What's the process of that.

And how long of the distance that you need to push that equipment from one point to the other and where it will, maybe it will end up in the public waiting room that you don't it to be.

And you also wanted to look at the time of the day, also look at the volume, like how much equipment that you will need to push around the hospital on a daily basis.

And on the right hand side, we're trying to map how the distance, the flow of the equipment.

So in this specific example that it starts from the central store processing department.

And then it goes down into the hallway and then go down in the public space and go down to the elevator and goes step to the surgery floor.

So in that case, you do not want the visitor in patient to see the offstage scene, right?

You don't want patient to see you're pushing a car around that has all the medication supplies in the car and that no, you also do not want to see patient on the stretcher in your waiting room.

So I think flows is very essential for the design as a hospital for all different user, like for staff, patient as well as visitors.

- And what was interesting here is, you know, I think the staff are so, you know, they come up with ideas, they make something work.

It's incredible.

The things that they do.

And so these older facilities it's, well, you know, it gets offloaded at the dock and then we take it to this room and then it sits there until some one else comes from surgery and picks it up and brings it to this room.

And when we start mapping out, you know, what's their existing flow, oftentimes it's a result of the spaces that they're dealing with.

Well, why do you need to take it from, you know, this room to that room?

And why is there waiting time in between here, which we would consider waste, right.

And come to find out it's well, the other, room's not big enough to store that many carts.

So when we're looking at the design, let's not put those same inefficiencies in the new design, but let's okay, well, let's make sure that next room is the right size so that you're reducing the amount of steps in the process and eliminating that waste.

- Right, right.

I think in the demo project that you just introduced, I think natural light, natural ventilation is the key.

But in here I think efficiency is very crucial in the design of the U.S hospital.

So in here we're showing other techniques that we view in the lean designs, including five, as thinking and here just five thinking, just a way to help them to develop a new product.

So the users, they were asked to bring everything that we need in this.

This is a path through yours, so we would ask them to bring everything that we need here.

And so what are the things that you think you actually need in a new design and it organize them in a good way and then design each layers perfectly.

And in the middle of this, is what we called rapid prototyping.

So we'll print out this like computers outlets, just on papers, on a sticky note, and then it's very easy to move things around just to test out if this is working, if not, we're gonna move this two inches over or two inches above.

So it's just a quick way to test out the space.

And then the third image here, we printed out the 3D medical equipment models.

So the user, they can play with the model, do a little bit of simulation, just it's a good way to help them to visualize this space.

And the last image on the right here, is the real mockup of the equipment.

So we talk a little bit more about this later, - But I think as architects, you know, we are used to looking at plans all the time.

But the hospital staff are not, but you show them, you know, the surgery table and you show them like, you know, this little red man is you as the surgeon, all of a sudden he's engaged.

And well, I stand here by my patient and I need a table next to me.

And the chips, you know, really helped them to engage with what's their flow in the, the room itself, as opposed to looking at lines on a drawing and asking, well, how big is that?

Oh, okay.

And trying to think like, is that big enough for the space that I need?

You know, I think that was a much more engaged process.

- So this project has two flows of ORS I wanted you to know this, that in the middle, there is a white space.

So that's the light wall that we introduced to this project.

So compared to the demo project, which is more linear, small for print right now, U.S project, typically they have a enormous large floor plate, right?

And the space in the middle is usually do not get any sunlight.

So back here, we try very hard to introduce light into the space, deep into the space, So that's what those two, white box are on this floor and all ORS, they are universal, so they're designed identically except for the two neuro ORS that are connecting to an iMRI.

So in here, the key is just to make the rooms the same.

So when staff come in supplies, are the exact same location, so that will reduce error and also require less time in hunting stuff, and also it's, I think it's universal for different specialties.

And on the right hand side, these are the universal pre-op and post and visual care units.

So, on these rooms are also designed identically.

So under ideas in the morning, maybe you have more patient coming in needing to use the pre-op rooms, and in the afternoon they're out of surgery, maybe all of them, or most of them needing to use a PACU.

So by doing this universal pre-op and PACU layout, it's very easy to flush the unit up and down to hand down the knee.

Again here, what showing a few of the lean design techniques that we used through the process.

So the two image on the very left, these are the gaming shift.

We use the gaming shift during the programming phases, so we just cut out the spaces with colors and we ask the users just to move them around.

And we want them to have a sense that they're engaged in the process.

Actually they have control over the space and in the middle.

So these are the 3D printed medical equipment chips.

And we also printed the surgery, a background pretty large.

And then the idea is just to ask them to simulate to process.

Where do you want your surgical table to be and patient heads in first or foot in first.

Where is the ideal location for the charge nurse desk?

So I think there is an inner child in every one of us.

So whenever we take out the chips, they just gather around and start playing with it.

So we don't even need to introduce how to do this.

They just start playing with it.

- It's a very intuitive approach for them and sometimes you have to get them started, but once they start, they're usually pretty engaged throughout the whole process.

- Absolutely.

- So, it's actually a really fun process to go through.

And we always, at least we, I think we like to say that, you know, we do this quite a bit, but we're not the experts necessarily.

They're the experts, they're the ones that are living and breathing it every day.

So, you know, who best to help inform the design than- - Themselves.

- Than themselves.

- So lastly, we used the real mockup because it's very hard to tell the elevation of an equipment or what's behind it.

Even with the gaming trip, with 3D models.

You have to be in the space in person to tell, there's a monitor on the wall, but can I actually see it?

Are there booms in front of me that are blocking my view?

So I think being in the actual space, give them a sense of what it will look like eventually, like just Renee was saying that you have to see the real space just to know whether it will work eventually.

- You know, it's interesting during the pandemic, because a lot of this stuff wasn't happening in per person, starting to open up a little bit now, but we used a lot of virtual reality kind of simulations to make that same, give you that same integrated feels as much as possible, you know.

Unfortunately, sometimes people get motion sickness on those things.

- Yeah, I do.

(both giggle) - But it was a way to kind of another way to look at the room without having to physically build it.

- Right, absolutely.

So this is the a nursing unit.

These are a standardized nursing units.

So at the beginning of design, we test out so many different back flow options.

The design considerations are, we need two units on the flow plan and hopefully, ideally, they can share some support space in the middle.

And we want all of the rooms to have good views.

Hopefully, they do not look into each other.

So the H shape layout we tested, it's I think there are two identical units, but I think the connection in the middle is too skinny.

So it's very hard for them to share spaces between the two units.

And you can tell that half of the patient room, they are actually looking into each other, so that's not ideal.

And then we tested this, what we call it, the sheer screen and the two units, they're not identical.

And there is few rooms, they're still looking into the unit next door so that's not ideal either.

And then we test this, what we call is the bow diagram.

And we introduce the curve and I think most of the patient room down south, they can see the New York city line, which is great.

And then we have two identical units, but we're thinking, okay, we need to add a scalar in the middle, so the middle of flow play gets some sunlight.

So we started to shift the two units apart.

And so that's where it came out with the diamond scheme.

And then let's see if we go to the next one.

So this is the final design, two unit curb on the south two identical units, and we share support space in the middle and it will have light walls that goes from the top down to the surgery space that we just look at.

- So I think this is a great example of how the big picture kind of moves affect the individual experiences.

- And then you, if you compare this with the Denmark project, it's still a very big floor plate.

And the support space in the middle is so fat, and the nurse station is in the center of the floor plate instead of at the end of the unit, like the one where they just presented.

So I think in here, it's all about efficiency, short walking distance from the nurse station to the patient room and the visualization from the space into the patient room.

So a few more lean techniques that we used, I think we talk about the five as techniques.

We use that to test out what we call this is the path through neuro server.

So it's used to store supplies and medication into the patient room.

We started from the conceptualized.

We asked the users just to write down what you think that you would need in this room on a sticky note, and then asked them to bring over the stuff and then organize them.

And then this one is the carbon mockup.

And then the write hand side is the final solution.

This is just a quick shot of the building.

I'm standing on the second street.

This is the second street.

So the towers on top, I have two floors of surgery and multiple bed floors on top.

And then you have the rest of campus on the left, and then you have your parking straw garage on the right hand side.

So this is really a complicated project on a very complicated side.

I would like to end with the story.

So in one of the user meeting, one of the surgeon was not able to join and, but he still wanted to meet afterwards.

And then he came after the meeting and said, I want to take a look at the drawing.

And we were discussing the surgery room so I brought up the drawings.

The first question he asked is where is the window?

And then I look at him confused.

He looked at me confused.

(all giggle) So there's no windows.

Ah, I just got relocated to the U.S. We always have windows in the surgery room.

(all laugh) I was like, no, not here.

So I thought that was quite interesting.

- Yeah, that's interesting.

Well, I'll try to be brief here where I get to talk a little bit about pediatrics.

Like I said, I'm a kid at heart and I love the different aspects that pediatric architecture offers.

This is St. Jude Children's Research Hospital, and we fit out three floors as inpatient units.

And for those of you don't know, St. Jude's deals with some very complex childhood diseases.

And it also deals with a lot of cancer so the families are here for extended periods of time and very difficult situations.

And it's, you know, families never have to pay for their care here.

So that's something important.

So you mentioned that floor plate was big in terms of the kind of with the support area, in terms of the square footage, pediatrics can be even bigger.

And so just to show you here, the little plan on the right shows how we pulled away the elevators in order to create what I like to call a loft floor plate to give you more usable space for the support because in pediatrics there are several things that impact the square footage.

There are unique spaces that you only see in pediatrics such as playrooms, you have toddler playrooms, teenage playrooms, you have music therapy, you have a variety of different spaces.

That's what you see in blue.

Then on the family side, you know, we mentioned earlier a little bit about the care that the family can give well with kids.

You know, lots of times you have mom and dad coming, you have sibling, and so creating adequate family space becomes really important.

You can see here, the room is fairly the same.

I mean, you have the staff area, the patient area and the family area to the south and your own toilet but what's different here is they went through the investment of creating a family suite or a parent suite.

So they have an offstage area you work at, to sleep in.

You have mom and dad sleeping in the same room potentially, and they have their own toilet and shower.

So it's quite the investment.

When you look at it as a whole, it's a lot of square footage.

So just something to think about, it's a little different about pediatric.

This is the kind of what it is looking like from an architectural standpoint, you can see that even the separating wall between the parent room and the patient room has as much transparency as possible.

The playroom, again, it's not just a playroom.

It's how do you clean the toys, that requires extra square footage?

And then there's the added piece of theming.

So how do you introduce the theme and how do you do it in different floors or throughout the hospital?

And then designing purposeful interactions.

So a hallway is not just a hallway.

It can be a path of discovery.

Some of these areas, you want to create zones that you purposely put distraction elements.

This is a integrated screen that uses gesture technology and the kids can go and learn about the animals and it's all related to the theme.

We also bring in the idea of scale.

Kids are not the same size as adults.

They come in all shapes of sizes.

So thinking about the kid, there's this tall and wants to play with something at the desk, you know, whether it's a shadow box or lights, or the other child who wants to sit in a kind of the astronaut Cove, you know, and this is children's hospital of New Orleans.

So in contrast, this is a very large project.

It's 400,000 square feet of expansion and modernization, and it's done in phases to keep the hospital operational.

And so this is what I call a mega floor, but it has its challenges- - It is.

- With the distance you have to travel but it's built around efficiency, but I think it also has opportunities, opportunities to create a journey and special moments.

So New Orleans music, right?

Can you spot the theme?

Can you see the guitar pick shapes and the long neck of the guitar and the frets and the sound waves, all that.

It's not just an application of graphics, it's inherently built into the architecture and you can see how that shows up here.

You can see the scale with the cubbies that look like musical notes, but how do you do it in a sophisticated way that appeals to all ages?

Because it's not just about kids, it's about adults, it's about the staff, it's about the families and it needs to stand the test of time.

I think so here, you see some adult spaces, the ceiling looks like piano keys, so you still bring in that theme within the architecture, but maybe it's a little more adult and feel the image on the left, same thing, that's the chapel.

Again, scale, you know, kids playing with the little light features at the desk, or these little tiles they're filled with liquid, they're squishy.

I had one of these at my desk as a sample for like a year and every day I would step on it, you know, and move that little color around.

In contrast to the, you know, the high tech things, this is a very easy, low tech solution that can be, you know, - Positive distraction.

- Yeah, positive distraction, it's affordable.

And then I'll just kind end with this is that sometimes a building can surprise you in the sense that it has a transformational quality.

And so kids love surprises.

One of the things I always like to think about and us as designers like to think about is how can that building transform that experience at night.

In conclusion, I think that you've seen some interesting comparisons between adult architecture in different countries.

You can see the big picture impact that code can have on your planning.

You have seen how there are lots of similarities with safety standardization but, and you've seen the impact that pediatrics can have on the human experience.

So Human-Centered Design, it's big pictures, small details, it's the process, it's designing empathically.

Hopefully, we've enjoyed.

Thank you for showing, letting us express some of what we do and how we do it.

- Well, Mezio, Zhouzhou, Renee, thank you.

What a incredible presentation.

I think you hit the nail right on the head you gave us comparisons, you gave us scale issues, you gave us reasoning for why design decisions were made, a powerful presentation, I want to thank you.

On behalf of everybody here, we have a few minutes left, and while we have a little bit of time, I'd like to open it up and see if some of the students in the audience have questions for you.

So if you'll speak up, if you've got a question so that maybe the microphones will pick it up or I'll repeat it, if I don't hear very well what you're saying, questions, anybody?

- [Peter] I have a question in all of your examples, you talked about the flow of how the building was built around.

So that way people can easily get from one department to another, there's no holdups, no wasted time, but with the first one, when you talked about the floor with, they were planning to use robots to train support medical supplies and even move patients around the hospital itself, do you believe there might be any problem with that?

If like a machine breaks down, like spin in the hallway or something that could actually mess up hugely with the flow of the hospital.

- Thanks Peter, go ahead.

- Absolutely, so, you know, I think this is something that personally I haven't seen done in the U.S at all, and over there, certainly I'm sure they'll run into those issues.

Of course, you know, there will be opportunities for a staff member to retrieve those materials if needed and hopefully they've got it to where it's, you know, enough time that they can make a timely, you know, response, if they need to go get something.

I'm sure there are challenges with that.

I don't know them personally.

- I think lots of times there's some redundancies built.

And so there are backups and so forth.

Also hospitals employ, you know, they have a biomedical, a department that fixes on site, a lot of these pieces of equipment, you know, and then redeploy.

So that's, you know, it's not just this, it's pieces of equipment that are used within the operating room, for example, you know, those will break down sometimes.

So having that backup ready to go, I think is one way of handling.

- And I haven't seen that in reality so, but I'm just thinking out loud right now.

If the machine is running by itself, maybe you can put an RFID track on it.

So it knows, it has been sitting there for five minutes, maybe there's something wrong with it.

I need to go and check it out.

- Exactly.

- [Kirk] That's exactly how they're designed so that they know exactly where they are.

Great question, another question.

Yes.

- [Student] So I have a question mainly about the natural ventilation aspect from the Denmark facility.

I love the idea of natural ventilation.

I think assistive ventilation is better than any other type of HVAC or natural ventilation having that assisted flow to get the fresh air in out, especially in a pandemic era.

But my question is, what are some of the things that we can do in our hospitals here to increase these, like promote this idea of natural ventilation throughout where you and oftentimes in the hospitals have negative pressure rooms, where you have infectious diseases, we can't have that get out, but we want it out in the air, but where is that air going?

Is it going to park right outside, and so, I don't know, but these are just different questions that- - Yeah, I can, I think I can speak to that.

I think in the Chinese model, we have mega hospital.

It's usually, you can see like hospital with a thousand beds.

And in that hospital, we have a designated infection control building.

And in design of that campus, you will look at the wind flow and then you will locate a building in a location that, when the wind blows, the air won't go to the other buildings.

So you will locate a building in the site that will not affect other buildings in that sense.

- And we do, you know, here in the U.S, every project that we were associated with does wind tunnel testing, not just to look at that, but also other types of exhaust, like from your lab or from some of your systems, and separating intake and exhaust, for example, even from the dock, you know, but also, a lot of the spaces in the hospital are required to have a certain amount of air changes, per hour when you're dealing with code.

And if the pandemic has done one good thing, I think it's brought this a little bit more to the forefront in terms of the quality of the air in the hospitals.

And so thinking about just increasing air changes, for example, in an ED, because it will help.

Not because it's necessarily just code required, but creating whole units that they may be buried and not have access to the natural ventilation, but they're gonna have 100% air changes per hour.

So that's a form of natural ventilation in a sense.

- I think another thing in the U.S I've seen a few times maybe, is opportunities where instead of opening the window in the patient room, can they take that patient and actually roll them out onto a roof garden to bring them to the outdoors instead of bringing that natural ventilation into their room, but introducing them to the outdoors to get, you know, their, if they're there for a month, then a lot of times they wouldn't be able to get any fresh air, but having those opportunities, I think would , I've seen it done that way in a few places.

- That's good question.

Somebody else.

I know COVID is really causing us to see an awful lot more of a hundred percent outside here because not enough isolation capacity was originally designed, so they're shifting over.

Who's next, I can hardly see you in the dark.

Go ahead and speak up.

- [Student] So I just had a question about the hospital in Denmark.

Obviously, it's a different project, it's a different culture, it's a different country.

Can you kind of talk about, or talk to how you guys we're able to tackle like that difference in culture when designing, because sometimes what is successful or what we see successful here and what is successful, like for example, Denmark for their standards, there's two different things.

And I know that can be a little bit problematic.

- Absolutely, I know the Senior Medical Planner on the project tells the story about, on the week and he went home and he was throwing the first concept of what the planning might be for this new hospital.

And he said, when he showed up on Monday with his idea, he was laughed out of the room because it was, I think, very similar to what we saw in the U.S, this lean mean efficient, very dense footprint.

And that's just not the, then over there, again with the codes and things and bringing natural light in.

And so I think what was really helpful on this project was working in tandem with the local firm there, KHR architecture because they could bring a lot of that understanding of the local culture and, you know, what's accepted, what's done as well as, benchmarking some of the facilities that are around that location.

So I think there was things like that obviously coming from the U.S, had we not had that partner firm, I think it would've much better.

- You'd gone on vacation there for like two months.

Is what you're saying.

- Exactly, so yeah, the cultural context is extremely important in the hospital.

- Well, and that's happened on with other projects that I've been involved where they're coming from different countries because they want to borrow some thoughts and ideas from the U.S, but then when you get to certain things like the square footage.

For example, something said, oh, we don't, we can't do that amount of square footage where you know where we're at because we just don't do that kind of investment.

And the idea of space is different there too.

So, you know what seems like, well, I'm sitting too close to you, may not be the case that way in another country, it's like, why do we have so much space between ourself?

- And then the code is different.

I think there's one line of code or occupied room this window, that one line will change the whole concept of the design.

- Yeah, the Chinese hospitals essentially require that all patient rooms face the south for sunlight reasons and so on.

Good question, another question.

Anybody else?

Yes, go ahead.

- [Student] I had another question about the coding for kind of integration with the natural ventilation.

Just how did it, or how do you think some challenges maybe solve, design a hospital here in Texas using this Denmark hospital as a president thinking?

Well, our glazing cannot be the same glazing in Texas for 2021 is 30% in Denmark that probably is not the case much higher.

They have less impact from the sun.

They want more sunlight here.

We don't want any sunlight in our buildings at all, almost 'cause it not cost effective.

So how can you see that?

Where in hospitals they have much more expand budget.

Is that maybe something that it's okay to have those energy efficient windows and just have thousands of them is that cost effective to them.

They can get people out faster and more people in.

- There's a lot in that question.

Well, I think that obviously, you know, you should tailor the design to where you are, right?

I mean you gotta kick into consideration climate and think in sense, you know, passively in terms of, you know, which direction am I facing, where does it make sense to add more glass facing north, for example, consider also the quality of light.

I think there's strategies you can employ with shading devices or overhangs and creating, in Texas, it's like having a shaded walk is extremely important, right?

You want to be able to get out of the sun.

So does the public, you know, circulation step back from the edge of the building to allow you to have that shaded walkway, on the exterior or even if it's on interior to shade the glass, to your point, you know how, and of course there's energy efficient glass, but you don't want to pin it all on that either.

And it gets expensive too, to do it that way.

- So thanks again, Renee, Zhouzhou, Mezio, fabulous presentation.

I see our hours up.

Thanks everybody for tuning in.

Thank you.

- Thank you.

(audience claps) (upbeat music)