- Good afternoon, and welcome to the Architecture for Health lecture series here at Texas A and M University.

My name is Ray Pentecost.

I'm excited about our speaker today.

I tend to be excited about all our speakers cause they're all such high quality.

Cliff Harvey is our speaker today.

And I've known Cliff for a while.

I actually met Cliff while we were both involved with an international organization, ultimately in leadership, both of us with that organization and I've enjoyed our friendship ever since.

He brings a perspective to my world that I have come to value and greatly appreciate.

I'm gonna read a few things from his bio and then tell you why they matter.

Cliff with lots of initials and credentials and honorifics behind his name collaboratively leads organizations through the planning, design and implementation of capital infrastructure projects, allowing healthcare organizations to stay current and position themselves for the future.

Cliff works and lives in Canada, heavily involved in the healthcare system up there.

Now here's an important part of his success.

Cliff's Management skills, and now listen closely, his management skills in design research supports a culture of innovation, creativity, and transformation.

That's important.

It's always leading edge.

Cliff's professional career includes being senior architect in the Ontario government, a senior hospital executive and practicing architect.

He's an international speaker on health and design.

I have followed his career in that regard now for well past a decade.

He's currently the chief planning officer for Niagara Health and is leading the development of the New South Niagara Hospital.

So with that as a brief introduction, would you please welcome my good friend, Cliff Harvey.

(applause) - Thank you very much Ray, and thank you for this opportunity to speak with you and share some of my insights.

I have a presentation which I'm going to pull up here.

Let me just do this.

If I can do this and it should have.

There we go.

Okay, let me just go back here.

So again, thank you very much for the opportunity to speak here.

I am gonna speak from a Canadian perspective on designing, planning, implementing and operating hospitals in Ontario, Canada.

And I also want to focus on something that over the years has brought me a lot of insight, which is these are complex projects and they need a different way of thinking.

So I'm really gonna focus on managing the complexity in healthcare.

Before I do that, I do want to acknowledge that I'm sitting here presenting to you from Toronto and I want to acknowledge the land that I'm standing on today is the traditional territory of many nations, including the Mississaugas of the credit, the Anishnabeg, the Chipewwa, the Haudenosaunee, and the Wendat people.

It is home to many diverse First Nations, Inuit and Metis people.

I also acknowledge that Toronto is covered by Treaty 13 of the Mississaugas of the credit.

Some of you might be familiar with the International Union of Architects and this year was declared to be the year of Design for Health.

Acknowledging that health is a complex problem.

It's complex in the sense that it's just not about one thing.

And what I want to talk about today is how architecture isn't just about particularly healthcare and hospitals.

It isn't just about restoring health, but we can also develop projects that develop or restore health, develop health and protect health.

And there's more of this information if you actually go onto the IUI website, which is located.

A little bit about the presentation, you'll note that I will have links to different information that I'm going to speak about.

Also, you'll see little references to books.

I'm an avid reader and I love continuously learning about what's happening in the world.

And this is an opportunity to share some of those readings with you that support some of my thinking.

Ray did a great job of actually giving a good bio from my perspective.

One thing that I'd like to share with you is that my journey has been somewhat of a unique in terms of being an architect.

I'm a professional architect, registered in Ontario with the Ontario Association of Architects.

I became a senior architect for the Ministry of Health in Ontario, responsible for approximately 14 million people, building almost 120 projects in my term, approximately about $40 billion work.

That gave me insight to being, what it means to be a policy maker that can actually do exactly what the design for health is trying to do, which is develop, restore, and protect health.

I went on to become vice president and now chief planning officer for two hospitals in Ontario in developing projects.

And over those years, I've volunteered quite a bit and Ray made some reference to that.

I've been volunteering extensively with the Canadian Standards Associations, which developed standards for the Canada.

It would be equivalent to both the Facility Guidelines Institute, the FGI in the United States, and we have partnerships with them, as well as Ashrae in terms of the heating, cooling, ventilation.

Also partake on an international basis in different communities and support the development of programs at university level at University of Toronto and the Ontario College of Art and Design University.

The reason I share this with you is because I think it's extremely important to have a well first network of diverse thinkers to help to inform your thinking about how you approach these, particularly as you move up into leadership.

So I encourage everyone to continue to stretch out and become part of different volunteer associations to move us forward as a profession.

Okay, so this brings me to where I would like to talk about today.

Solving complex problems.

So design for health is a complex problem in the sense that we're driving towards addressing some of the world's most complex issues facing the health of the world today.

So responsibility of individuals, collectives, and nations to protect, promote and restore the health of the world.

What I'm gonna use is a South Niagara project as a case study.

This is a project that Ray made reference to that I'm working on right now.

It is a culmination of a journey, as I mentioned before, with my experience both from a policy making (indistinct) to understand exactly how we would be able to incorporate what we need to do to move us forward, just not Canadians, for everyone, one project at time.

What I'm gonna say is addressing these problems needs the new types of thinking to plan, design, and manage these projects.

The learning objectives for today's presentation, really I'll leave these with you and I expect that you all will have access to this presentation both on the recording, but also I hope through Ray, they'll make it available to the student as a file.

But really four things that I would like you to take away from today is that really to move us forward, you have to understand the problem first and the solution second.

I'll talk about that.

That the people matter.

You collaborate with leaders and organizations, the diversity of thought is absolutely key.

One of the favorite things I like to say is that technology integrates, people collaborate.

We often talk about an integrated project plan, that's great for the deliverables, but the only way it gets accomplished is to be able to collaborate.

The other thing is that process, I use the 80/20 rule.

80/20 means that 80% of what we do in healthcare, particularly around hospitals is standardized.

We should use those to move us forward.

But then the 20% is what we should really focus on.

That's the innovation.

How do we move ourselves forward focusing on the 20?

And the last one, and I hope to get here to speak to you about this, if not this was an opportunity maybe to give you a sneak preview for a future presentation, is the design spaces for innovation.

You know, we all speak about evidence based design.

There's also something that we focus on which is research influence design and design management.

So using those learning objectives and thinking of that, you have to think differently.

One of the things about collaboration and working in a large team is that we focus on being a learning organization.

So with the top bubble here where we have the five objectives of a learning organization, which is from Peter Senge's book, "The Fifth Discipline", System Thinking, Mental Model, Personal Mastery, Team Learning and Shared Vision.

Those are things that constantly reoccur through our development of our project.

And it's constantly talked about when we're developing larger policies across the, both in Ontario and across Canada.

And I'll say this is sort of a stop point for me where design thinking is an element.

Architects do this very well.

In fact, the argument that I strongly support is design thinking actually came from Peter Rose's book in 1987 called "Design Thinking".

And then everybody sort of latched onto that.

But it is important to think that if we're gonna solve these problems we have to think differently.

And the reason I say that is that this is from Rittel who developed the theory about wicked problems.

And if you've done any work around complexity, you recognize that complex problems are wicked in the sense that they are a system that constantly is under pressure.

The healthcare system, and I'll talk about this in Ontario a little bit later, it's constantly under pressure for many other elements.

It's not a closed loop system, it's an open loop.

Often we think about as architects that these are tame problems, that is they require creative solution but we focus on generating ideas rather than understanding the problem.

But today we have such serious problems in terms of how we address the health of the world, is that we have to think about and understand the problem first and then we recognize the wicked problems and then we recognize that we have to consider and seek unique solutions for that.

With that kind of thinking, that's where we've come to the South Niagara project.

Gonna switch gears here a little bit.

So that's the basis of what we're gonna talk about.

But in fact I'm gonna give you a little bit of a history of of the South Niagara project and where it's located.

It is located in Niagara Falls, Ontario and across the border from Niagara Falls, New York, dislocated outside Toronto.

And that it's an acute care facility with post-acute care and ambulatory as well.

It's a 469 bed facility.

It's approximately 1.2 million square feet and it will be a center of excellence for complex care, wellness and aging, stroke and geriatric and geriatric psychiatry as well.

It also is going to be the wealth First wealth certified healthcare facility in Canada if we're successful in achieving that certification when we open.

Using that as a basis for the project that we're talking about, I just wanted to give a little bit of a background to the Canadian public healthcare system.

Cause again, one thing that I'm always stressing is that you have to understand the problem that you're trying to solve.

Canadian healthcare system, it probably everybody's familiar with Canada, but just give it a little bit of perspective with a population of 35 million, approximately about at 10th the size of the United States population but about the same amount of size.

Ontario, the province that I live in is about 14.6 million people.

If there was a state, it would be the fifth largest state, and city of Toronto is 2.9 million square, sorry 2.9 million people.

If it was a city in the United States, it'd be the third largest city.

And then word Niagara is greater Toronto Hamilton area, which approximately has about 5.9 to 6.9 million people depending on what you're including.

That's the area where the South Niagara project's actually located.

I throw this in cause this is fairly important in the sense that when you start to understand when you're designing a project for the health of a region, what are you designing it towards and what are some of the problems that you're trying to address?

This is from a paper on the Canadian Universal Healthcare System and achieving its potential.

It gives you the stats.

I won't spend a lot of time here speaking to this, but it gives a good indication, particularly when you're doing research and trying to understand internationally what's happening and what's some of the solutions other countries are doing to provide healthcare and facilities to address the health of the population.

Just note down on the right hand corner there is the book "Healing of America" T.R Reid, excellent book if you're interested in public healthcare systems because he goes around the world and he actually investigates all the different healthcare systems and where they came from.

Just to give your perspective, the healthcare system in Canada was founded in 1947.

So truly it's fairly young system.

Germany has a much older system.

And this is the last slide I'll have on the Canadian healthcare system, but I just wanted to point out that it is national, it is brought by all provinces and territories through the Canadian Health Act.

So it's a federally run program, but it's administrated from the provinces and territories.

So that means that all 10 provinces and territories have their own healthcare system.

Therefore they have their own approach to how they deliver healthcare, how they fund healthcare from a capital point of view when they build their facilities.

And then down below you can see that the three layers of the healthcare system in terms of funding, layer one is really what most people think about because it's our hospitals, it's our physicians and diagnostics and it's a hundred percent funded by the government.

One thing that is often overlooked is that in fact, we have a mix of public and private healthcare, and you see the last layer number three is the healthcare system that, the healthcare services that are dental care or vision care, which is actually paid through private insurance.

Approximately 78% of Canadian healthcare is covered from a public point of view and the rest is covered through having insurance.

This also is important to recognize as architects because the different systems have different types of facilities and they have different needs, who you're addressing, also have different funding.

So again, working inside the Canadian healthcare system, you have to recognize where you're working and who you're working for and how they're actually being funded.

For working on Ontario, this is the Ministry of Health Capital Planning process, and it's pretty straightforward.

And this is where I kind of talk about the 80/20 rule.

When I was with the ministry, I was responsible for actually the technical review for all the facilities that came through.

Right from the beginning, you start with a clinical service plan and you do the planning, you go into the blue, which represents more of the capital planning, the functional programming right through to what I always call day six, which doesn't exist in the ministries process, but six is really around the operations of the facility.

This is where the 80/20 rule comes in because down below you'll see a number of Canadian standards association's standards, including on the left hand side, the Canadian healthcare facilities standard.

This is equivalent to FGIs standard, which is the designing for healthcare facilities.

I will note that we have other ones, including the HVAC, way finding and infection control.

These are key because we've done a lot of work.

I mentioned earlier how the Canadian healthcare system is 10 provinces in three territories.

They all have their own capital planning branch, they all deliver their own healthcare facilities.

The standards go right across the nation.

So what happens is that the standards for billing a hospital in Nova Scotia or and Vancouver are going to be using the same standards.

So 80% of what we do is standardized.

That's great because what it does really means is that we have 20% to actually focus on improving the system.

I'll throw this in in the sense that Infrastructure Ontario, which is our procurement agency for procuring hospitals, has a different models.

We are a P three, so a private partner, excuse me, a private public partnership.

And we're a DBFM model.

That does affect how we actually plan for our facilities, but it just adds to the complexity or the complications of actually building a hospital on Ontario.

This is where we're gonna start to switch over to how these investments that we make are so important to, again, going back to the design for health, promoting, developing and restoring health.

And often people think of hospitals as the restoring part, but there's a great opportunity.

And the reason I say that is this is a comparison to paying your annual spend in Canada at $242 billion annually to deliver healthcare versus the $8 billion we spend on the left hand side on a capital point of view.

So $8 billion a year we spend on both buildings and equipment, and then we spend $242 billion annually.

What I really focus on is at the bottom, which is says capital investments in your facilities, the biggest strategic, biggest quality improvement project that any healthcare provider can undertake.

This is our opportunity to start to change the world one project at a time.

We can really focus on what we accomplish through these projects.

So I'm gonna take you through what we've done.

And the importance of this from my perspective is always looking at how projects can take advantage of both the investment they're making but also the opportunity to make a change.

One thing that we did, and I'll just note here when I was talking to Ray about this presentation was there was some discussions about, well what opportunities are there to work in Canada in healthcare?

I will say that it's a cross border sharing of information, of sharing of knowledge and that firms constantly come over, back and forth.

Example, previously I worked at North General Canon, Architects were our prime consultant, although they're close bias and Grand Island in New York, they're working right across the border.

Very similar.

We have architects working for us that are Canadian based that should go down states, I'll talk about that.

Over, I've highlighted it with the red bubbles, the different firms.

This is actually one of the most important aspects that we did, which was we work with multiple forms.

This is often thought that you just hire one firm and they bring you all the services.

We really wanted what I call the diversity of thought, the expertise from different firms to work with us.

So dialogue did this work on the visionary report.

One thing that it goes back at the very beginning, I didn't speak to it, but one of the things about solving these problems is bringing a rigor to the design process, the design thinking process.

And everything that we do, we start with, and you see it in the table of contents here, an understanding phase, then we do an analysis.

We do an engagement, then we bring all that information, do a synthesis, and then we create, and that's a typical design thinking design process.

But we're rigorous about this because often people just go into the analysis and they don't do the understanding.

So we did this report, this was the first thing that we did when I arrived at North York, or sorry, at Niagara Health.

And one of the things that dialogue developed along with the conference board of Canada, and this is available again for download, is a community wellbeing framework.

And this gave us the opportunity to actually look at multiple aspects of the project, just not from the restore, but actually the develop and the promote.

And you can see that there's five different domains in the middle, social, environmental, economic, cultural, and political.

And we looked at all those through the engagement process and came up with what is basically our design themes.

Let's just go through these really quickly.

These are all available online.

I'll talk about where you can find them in a moment.

So one was community health and wellness.

And I'll go to the third bullet point, which is build partnerships.

The hospital itself cannot provide everything.

Number two was focus on patient and family staff experience.

That absolutely huge.

And what we were looking at was the second one bullet point created diversity of spaces for different uses, quiet spaces, interfaith rooms, social spaces.

Third one was excellence in seniors health and wellness.

Go to the first one who's designed for geriatrics considering the increasing aging in the region.

I will say that Niagara region is one of the oldest populations in Ontario.

It's the second, if not the first in terms of having seniors.

And so that becomes a fundamental basis to making sure that we're addressing their needs.

Number four, with accessible, safe, and inclusive.

And I will focus on the third bullet point, which is incorporate territorial acknowledgement and consider all cultures in the hospital's design.

You have a slide to speak about that in the a couple minutes, but I wanted to focus on those were some of the outcomes.

And then number five is environmental leadership.

Again, those are pretty standard in terms of striving for low energy use and water consumption.

Number six was efficiency and innovation.

And I think that was where we started talking about technology.

So what we wanted to do was basically be a knowledge provider.

We took all those and actually created our goals and objectives.

And you've seen these over and over again from a perspective of working in healthcare.

They're nothing too shocking from my perspective, but I'll tell you truth, working at the Ministry of Health, working with 120 different projects, I would see the goals and objectives at the beginning of the project.

And by the end, nobody ever talked about them, nobody ever measured them.

They weren't actually given performance indicators.

That's something that this project's actually changing.

We're actually measuring these all the way through and we're gonna measure them at the end.

Post data evaluations, they're not that often done in Canada.

We're really focusing on trying to promote that further and actually have a research standard that we've just developed.

So we took in these and we actually did them, but what I want to focus on actually is the next chapter that came out of the design vision, which was future directions and implementation strategy.

I'm gonna highlight the 6.11, which was the design reports and guideline documents.

What they're recommending is that if these were so important to you that we need to go out and study them, and understand them even more.

The exercise that dialogue did to us was great, but they said, we just touched on the surface.

If you really are going to change the nature of these, you really have to study them.

So that's exactly what we did.

We took our project goals and we did a number of studies, workplace strategy, community wellbeing, they're on the left hand side.

One thing that we've always said from the beginning is that we need to share the information.

There's no reason the 80/20 rule that other facilities have to repeat the work that we've done.

They can build on it for sure and it will get better, but they don't need to constantly have to go and reinvent the wheel.

So all these reports are available, they're available for yourselves if you want to go take a look at them.

And I'm gonna go quickly through how they do support the different aspects of designing for health.

The first one is protect health.

So what have we done?

This actually was a small thing, but in fact it sort of set the time frame and the understanding that we wanted to bring to the site, which is that in the site that's located on a greenfield site, we actually went in.

We had to remove a woodland, which is the bottom or the top right hand corner to make access for the facility.

But in doing so, we went through and actually harvested a number of trees and in fence acorns to actually plant and bring these forward and we'll plant them back onto the site.

So in sense, trying to protect and honor our site as it is.

The other thing I talked about is that we did these in-depth studies.

So WSP, the engineering firm that works both in Canada and the US did our environmental plan.

So they actually set our goals.

So we set a number of sustainability goals, including Well, and looked at the what you see on the screen, health and wellness, landscape and nature, transportation, materials and product, G and G gases, energy efficiency, water efficiency and waste reduction and recycling.

They went through.

This is the table of contents and went through each one of these understanding what it actually meant, setting our performance guidelines and actually setting metrics which we would achieve in our project.

Two things I'll speak about here is I highlighted the research.

For those interested in this, this is again, report available online.

It's got a number of case studies on hospitals that have recently built in Ontario that actually looked at their energy use, looked at their environmental report and gave us scorecard.

So a great resource there.

Second of all, I wanna stress that I probably should have said this at the beginning, we're just about to award the contract to build the hospital and we went through the DBFM process.

And in doing so we built into our RFP these goals, particularly around the energy, greenhouse gas emissions, a number of other things.

And I'm pleased say that the RFP is closed and we've evaluated, we haven't yet awarded, but that our proponents actually met our targets, which is very, very encouraging and shows that we are already on our way to achieving our metrics for the project.

And the last thing I'll say on protecting health is that through Stantec, who actually is our main architect at this time, is actually did a resiliency report.

This was actually the first resiliency report that was done for an Ontario hospital looking at what climate change actually means in the future and protecting our future by making accommodations for what we expect to be of the change in the climate, including future storms and flooding.

Develop health.

So how are we developing health?

Well, I think the Well certifications probably says it all.

From my perspective, trying to be the first Well certified hospital in Canada, we recognize the importance of this.

When I have to describe Well to individuals, everybody's familiar with the Lead program, which we're aspiring to.

Lead is for the building, making sure that sustainable and its energy use.

Well is really for the people inside it.

And this is where we really focus on developing the health for our staff and physicians as well as for our patients.

That's spending a lot of time about this because this could be a subject in itself, but I think this is a one of the key things.

The second one in terms of developing health is actually looking at our workplace strategy, creating a great workplace for our staff and physicians, particularly coming outta COVID where the human resource issue is not just in Ontario but is actually worldwide in terms of health human resources is so important that we consider that the spaces that we create for our workplace, for our future physicians is a place that we would all want to work in.

And B&H architects and advanced strategy, which I believe is their office in Seattle helped us do this.

And again, I'll just put in perspective, again, we were very clear that they had to understand, analyze, synthesize, and then make the recommendations in terms of how we would do this.

I'm hopefully might be invited back next year to talk about the design and how we achieved all these things.

But we do know that both proponents when they were designing our facility had met that.

The one thing I'll note, is the book on the right by Rex Miller is a really significant book from our perspective.

It helped us in that think about how we want to change your space, change your culture and that was a driving force on how we approached this issue.

And then design, when you develop health was very clear from a bio point of view.

The connection to landscape, connection to health was big.

Even though we're in Canada where our seasons make it difficult, particularly in the winter time to get outside, having access to outdoor spaces still is very important and there was a significant amount of thought put into the actual design of the facility.

And the last one about developing health.

Going back to the community wellbeing, often we don't think about designing a healthcare facility from an economic point of view.

We think about it as you can see on the right hand side with the wellbeing framework, the economics, affordability, complete community life cycle value and local economy.

We are working with our Niagara economic development partners to actually develop a virtual workplace trade show bringing businesses and supporting our local economy because there is a strong connection between the economy and health.

And then the last one I wanna speak to is restore health.

How are we restoring health?

One of our goals is operational excellence and improves.

This is where we start to really think about how hospitals restore health.

But they also do amazing jobs of protecting health, particularly with the staff and physicians.

We're one of the first hospitals, this is in one sense nothing to brag about where the United States has accepted a hundred percent single rooms for quite a while if it hasn't been a decade.

But in Ontario this will be the first hospital that is a hundred percent single patient rooms.

And this is significant and a great milestone for us.

It took us a while to get here, but we're actually doing it.

Again, when you're looking at restoring health, that's one of the key indicators is having a single bedroom where you've got quietness, you have access to natural light, you have all the safety features that you need, including fall protection.

So this is actually big from our perspective.

The other thing when we talk about restoring health and I made acknowledgement of both the land at the beginning but also in our design vision.

We talked about working with our indigenous partners.

We're one of the first hospitals in Ontario to have an indigenous health program inside the hospital.

There are a lot of community programs outside, but this is actually recognizing the acute nature of indigenous health.

And in doing so in our functional program, we've addressed it in RFP, we've actually included indigenous artists and architects to participate in the design of the facility and then working with the agreement and infrastructure in Ontario, we're also working on a workforce and we talked about the economic development, the workforce for indigenous partners and the engagement plan.

I'll point out here two books that are excellent to understand both the indigenous population, particularly "The Good Ancestor" because it does bring in the perspective of the seven generations and long-term thinking.

Something that often is overlooked in healthcare.

And to focus on restoring.

What we did was patient journeys.

So we actually mapped out a number of patient journeys throughout the facility, looking at their experience, trying to ensure that when we design our facility for them, we are promoting the restoration of their health and then eventually they're promoting their own health from that perspective.

And in doing so, trying to remove as many barriers.

This was a design exercise allowed everyone to understand how integrated a patient experiences from when they actually enter onto the site, parking, way finding.

Way finding is a major deliverable.

And if you go back to our reports, you'll see that we did a report on that.

The patient journey will be one of the performance indicators, patient satisfaction, how well we do with this facility.

Now just recognizing the time, I kind of joked with Ray that in fact I would try to do a small snippet of if you wanted to invite me back, how do you manage all this complexity?

So I'll take the next five minutes to kind of go through this very quickly to give you an insight to how you would manage all the complexity of all these reports coming together in one project.

And though the key is that this project, and I'll say it in a couple minutes, it'll take us 14 years to open up.

And in doing so, my favorite saying is never mistake a clear view for a short distance.

And so really what we had to do was understand where we were going, how we were gonna incorporate all these, how this project was going to not just be about a hospital, but about promoting and developing health for the community.

And to do it, we actually had to map it out.

And this is the first time I know of lease in Ontario where a entire project was mapped out.

Let just give you an indication, this map is eight feet tall and 30 feet long.

It has over a thousand sticky notes, which are all deliverables.

Color quoted to responsibility, has 18 different work streams.

And as you can see, it actually spans about 14 years from the inception to its actual construction.

The reason for it's so important is actually this, is the fact is that working with work streams in linear fashion, you often give deliverables and say, okay, you're gonna do the environmental plan, you're going to go off and do the workplace strategy, the F and FE strategy, you're going to do Well.

And what happened was when we mapped these out, we realized the interconnectivity of all these deliverables and you can see this.

And this was a shock to the engineer that was helping me do this.

A really good friend and colleague, but a man who thinks as a civil engineer in a very linear simplified process way.

When we started connecting these, he really started to understanding the integrated nature, but he also understood how important it was for you to collaborate across these work streams.

And it became really important to us because then when we wrote our RFPs, we knew exactly what we were gonna ask our consultants to work and who to work with.

The book on the left is an amazing book that actually helps you understand how you take complexity and chaos and you turn it into planning tools like these kind of roadmaps.

Just recognizing that everything I just talked about is all about collaboration and we're only now really understanding how a leader and an organization can collaborate.

I'll leave this with you.

The book on the left is the Harvard Business Review on collaboration.

This is from it and I'll point out the last bottom right hand corner, where does it work best?

Works for our diverse group across unit and cross company work where innovation and creativity are critical.

So if you're focusing on that 20%, then that's exactly where you need.

If you're working on the 80%, you probably can move over to command and control because it's all about executing past practices.

But when you really want innovation, this is where you need to go.

So you wanna work in an organization that has that collaboration and leadership.

I'll just say in managing complex project, there aren't just one project management.

This was actually a presentation that I just gave to university here in Toronto around project management.

And making the argument is just not about project management, it's really for me as an architect, it's around design management, which isn't given enough credibility.

This is actually the part that I'd love to come back and speak to you is actually how does, how do you manage the design to find that maximum creativity and move your project forward early in the project?

The trouble with hospital projects, particularly in Canada is that it's very focused on the cost of the project and most of the time is worrying about the cost of the project at the beginning rather than focusing on the goals and objectives.

We turn that around and we put our goals and objectives and we've made this project very affordable in terms of achieving those goals.

And I'd love to be able to spend more time talking about how design management makes that happen.

And the last thing I'll do, and this is the last little tidbit to see if I can come back and speak to you, which is about design research spaces.

So everything I talked about was about how we actually take the design and move it forward.

We did it through research.

I talked about understanding, I talked about how we did case studies, we did a lot of research for that.

That research influenced our design.

There's a great discussion, I've had it with Kirk Hamilton around evidence based design and research influence design.

They both work together.

Evidence-based design helps you understanding past practices and how they can benefit you.

But I always argue that to move us forward we have to look at research influence design.

So just recognizing the time, I think it's hopefully some questions, hopefully I addressed these.

I'll just go over them again.

Key is understand the problem first.

The solution will come second after that.

People collaborate.

Think about the diversity of thought, the process, use the 80/20 rule.

This is big particularly from a focus point of view of how particularly new in the industry you might be.

Everything seems new but in truth, standards have been here for a while.

They're the best practices.

That's why I'll just pick a plug for everybody to get involved in the development of standards and volunteer time for that.

Because number one, you gain a greater understanding of that.

But number two, it also helps move the forward.

And then that kicker is to come back to talk more about the design spaces for innovation.

So I will stop there and I'll say that has, the last slide does have my contact information if you're interested in discussing this further or have any questions, you can always reach out to me as well.

So I'll stop there and see if there's any questions.

I'll pull up the chat too.

- Are there questions here in the audience?

And I know Cynthia, you're monitoring online, so we'll be ready for those.

Cliff, I wanna, I have to say that was absolutely spectacular.

I was looking for the right word.

The clarity with which you grasp, protect, develop, restore.

The clarity with which you applied those to a new project, absolutely remarkable.

And it's the poster project for how a design for health model can make a difference in all three areas and how they can come together.

That's tremendous what you've been able to do on that project and for that community.

I applaud your efforts.

That's wonderful.

I am curious, for all of that vision and thinking and multidisciplinarity and 18 streams of activity in your flow chart.

Where did you have the hardest time getting people to understand the big picture?

- That's a really good question.

I will always say the most difficult you have is with working with government in terms of the ministry of health because they, when I talk about the 80/20 rule, they're very supportive of the 80.

When you bring the 20, they get very concerned because how much is it gonna cost?

What's the benefit from it?

I have to say, I'll just reemphasize that, that understanding that you do at the beginning and bringing people along on the journey helps you get the buy-in that you need because that engagement part.

One thing I didn't talk about actually is engagement.

We all actually did a course on the, through the International Association of Public Participation on engagement.

Because engagement has to be meaningful and it has to both be meaningful to us looking for information but also from the people who are engaged to be getting that information.

It taught us how to engage properly and this is...

I went through school of architecture with the whole intention, this is going back into the 1990s and eighties and nineties, that I never was given a course on how to engage, question.

And I know that has changed since that time that you do a much better job of engaging diversity and collaboration among students.

My concern is that those are the students, the people who are the leaders right now aren't actually aware of how to engage because if they're an architect in practice, they've only kind of learned it through trial and error.

And I will say I'll be the first one because I actually said we need to study this.

We need to bring our consultant in, we need to do a five, it was a five week course on how to properly engage our participants, our stakeholders, or I have to clarify that because I think this is an interesting, we call them interested and affected parties.

No longer using the term stakeholders because it has other connotations.

So there's so much to learn about that.

But to answer your question, I think we've been able to smooth the journey out because of our design process but also our engagement process.

- Well said.

Well said.

Cynthia has a question from online.

- It's from George Mann- - Cynthia, let's make sure we can get the microphone.

- I have a question from George Mann.

He was a little bit late, he missed the first couple minutes, but he'd like to know where he can see Canadian health facilities.

- I want to just clarify, is that the standard?

I don't know if George is there.

Cause the Canadian health facilities is our FDI guideline in terms of the title and...

Okay, I see he's online.

It's a central, so if you go to the Canadian Standards Association's website, it's available there.

But George, I will see if I can get you a copy as well to see.

But I think that's what you're asking for.

- Other questions?

- I will say one thing is that through the pandemic, the Canadian Standards Association made many of their standards available for.

They usually charge a fee, but they actually made them available, recognizing the importance for standards through the pandemic and proper planning.

- Well we're getting a little bit short on time remaining, but before we run out completely, I want to make sure you hear from me that we would love to have you back.

This presentation, Cliff was just superb and I'm eager to hear the next phase about how you managed the three major phases in the project to achieve the efficiencies and savings that you were pursuing while also making sure you achieved the goals that you set out at the beginning.

That would be fascinating and let's just resolve that we'll find a way to bring you back soon so that we can hear how all of that goes.

Are there other questions?

Yes, please.

Quickly so we have time.

Come on right here.

It's fine.

- Hi, thank you so much for your presentation today.

And I wanted to ask, I love the part in the beginning when you spoke about understanding who you're designing for where, and the funding.

Going off of the 80/20 rule, that graph that you showed in the beginning when you were talking about looking at other healthcare systems and globally the aspect, are there any specific places, countries, healthcare centers that are also going off of that 80/20 that you look at?

- Yeah, actually excellent question because we do model our system on other ones.

So the UK, so the National Health System, which is another public health care system has a number of, they're called health facility notes and they're like standards, so they're expected that they would meet those.

Australia also has standards, so there's basically three public healthcare systems that focus on that and others.

So usually the public healthcare systems are the ones that have the established standards from that perspective.

And then I do know France is also developing a set of standards.

So it is being picked up, which is great because that is the way we can move forward.

- Question, in terms of focusing on the indigenous, like practice, are there any that you also look at?

I know on the second screen that you showed, you talked about that portion where you said, I acknowledged I love that and I acknowledged you for acknowledging that.

Are there any other indigenous practices or anything that y'all look at before designing in the research part?

- Yes in terms of engagement, we engage our indigenous partners and they, it has been a great learning for everyone involved in the project and understand their culture and how they foresee using the hospital because their view of how a hospital works from a patient experience is different than how other people see it.

So again, a lot of engagement with our partners around that is absolutely key.

Also, we're starting to see more on an inter, I'll say a national level.

So I did put in the RAIC, which is Royal Architectural Institute of Canada, which is the equivalent to the AIA, has a workforce, or sorry, a taskforce looking at indigenous architecture, and indigenous practice and recognizing that as well.

So that is a resource.

If you go to the RAIC website, you can find more information about that as well.

- Okay, thank you.

- Thank you for your questions.

- You're welcome.

Thank you.

- Cliff, sadly, our time has come to an end, but this was fantastic.

Thanks so much for joining us, my good friend and we will have you back.

Thanks again.

- Thank you.

(applause) (rhythmic music)