Howdy, howdy.

Welcome to the 2026 Lecture series, Architecture for Health Lecture Series.

Today we have Ashley Diaz, principal and health practice leader from Perkinson.

Will joining us.

Ashley is a registered architect and experienced strategic planner specializing in health care.

She earned a master of Architecture and Bachelor of Environmental Design degree, with a focus on health care from Texas A&M University.

Yes, she's an Aggie.

She's also a certified lean Six Sigma green belt from the University of Michigan, and she has also certifications in lead and EDC.

Ashley has worked on top academic medical centers in the US, over ten pediatric health systems, and over 25 community hospitals to date.

So please help me welcome Ashley Diaz.

Thank you.

All right.

I think I missed up for the audio, but I think.

Can you guys hear me?

Okay.

All right, well, there's a few of us here that I think we could do a round robin.

I would love to hear each of your first names.

Know, George.

I know Zach is your pain, but if you guys could just intro yourselves.

I just love to know your name, so we'll just go like this.

Marley Morelli.

Right on.

Hi, I'm Brian.

Zach.

Maria.

Nice to meet you.

Right on.

Jennifer.

In the back.

Okay.

And I can't see.

That's right, I remember you.

Well, thank you guys for having me today.

So I am a class of zero six undergrad and oh eight for my masters.

I got into healthcare with George in my junior year, and from there found it to be a calling.

I'll give you a little bit of a bit more background than what was shared, so that you have a little bit of context as to why I'm sharing with you the content that I'm sharing with you today.

So I started my career much like you guys will probably be starting your soon with architecture firms, learning the ropes of being in the studio in professional practice, I started on a children's hospital in a health care studio after I got my certificate at HKS, and then from there I moved into a little bit of what I like to call the pre-designed consultancy world.

So I did some architecture work for the first five years or so, and then I moved into master planning, campus planning, strategic planning space really felt that that was a good fit for my talents, and then went to Blue Cottage for a little while.

I don't know if you guys have heard of Blue Cottage, but Blue Cottage is a very specific boutique consulting practice for strategic health care planning.

So did that for about 5 or 6 years, and then found my way back to architecture proper at Perkins and Will, where I could be both a strategist in healthcare and also be an architect, so I could be the hybrid professional that I had kind of become.

And so that line of work that a little bit upstream, you're upstream a little bit with the clients is where I like to spend my time.

It's the best use of my talents.

And so today I want to take you through a deck about altitude management.

So when you're a little bit further upstream with the clients, before a project is even a project before a project is a piece of architecture, they they've got to put their arms around.

What is the problem that they're dealing with?

How might they solve it?

Is it an architectural problem.

Is it an operational problem?

Is it a capacity problem?

So you're you're very high level, right.

And as you work through those things in a pre-designed consulting capacity, you start to solve the problem and understand it and get to a little bit lower of an altitude.

It may turn itself into a piece of architecture that might in fact be the solution, or a renovation of some sort.

Right.

And then that comes with its own decision making requirements, where you're working with maybe a slightly different audience.

At that point, you may be working with executives very early on, and then you start working with real estate senior, and then it becomes actual planning and architecture and design.

And you may be working with the clinicians and project managers that are in the planning, design and construction department.

Right.

And then it moves into construction.

And that's a whole.

So as you kind of get the point of what I'm wanting to share with you guys today is that at different parts in a project continuum, you're at different altitudes, and it requires different takes on how to facilitate decision making.

So this this deck actually is a AIAA for anybody that needs one so we can get a certificate somehow.

These are the learning objectives.

Read them.

If you feel compelled.

We're going to just kind of skip over them.

All right.

So I'm going to take you through.

And this is what I was sort of alluding to.

You start real early to strategic planning.

This is where you're just getting your arms wrapped around what may be an institution of systems or a campuses challenges that they're trying to address.

It may become campus or facility master planning where you're starting to look at their site.

Then it becomes programing because you're starting to define what might the spaces be that we need and what are the functions we're trying to address.

And then then we move into proper architecture, what I would call proper architecture.

Right.

We're in schematic design, design development.

And then we move into construction, totally different altitudes, levels of detail.

So what I'm going to do, possibly in my 20 to 30 minutes with you, is try to go through all four of these.

I know for sure I'll get through 2 or 3.

So I want to take you through a couple of different projects that I've most recently touched on in my career.

Renowned pick You pick You stands for pediatric ICU Intensive Care Unit.

So this was a project that has been built at this point.

So I'll show you sort of the finished photos of that.

But it didn't just pop into our worlds.

There was a whole evolution to how that project came to be.

So I'll spend a fair amount of time on the renowned pick you, and you can see I'm going to show you a large portion of that continuum of that project.

I'll share a little bit about a recent project that is is being dug out of the ground right now, actually North Texas, the UT Southwestern Children's Health, new pediatric campus.

My colleague Zach has been on that project.

Perkins and Will and HKS are collaborating on that very interesting project.

There could be a whole hour long lecture or more one, two, three, four day lecture on that project.

But I'll give you a little bit about sort of the early decision making in that project.

And then for sure, I want to tell you about MD Anderson, CSB, CSB stands for Clinical Services Building.

And some of the decision making at that point in the project.

Okay, so let's dig in and then maybe we can get to the Mayo Clinic as well.

But I'm going to spend the bulk of the time and I hope it's okay with the production guidelines here.

If anyone has a specific question that you just not, feel free to jump in.

I'm fine with that.

Okay.

Pediatric.

So it didn't just like, oh, we need to pick you.

So I'm going to take you away early.

So like I said, I spend a lot of my career in strategic planning.

So what what does that mean.

That's that's when the executives in a system, the C-suite, more or less the executive vice presidents, the senior vice presidents who are in charge of leading the health care system are grappling with their day to day challenges.

The things that are they're running out of space.

They're running into challenges and queuing whatnot.

They want to address access in their community.

And so they'll do strategic plans.

And so I play in that space quite a bit.

Here are some examples of what we did in 2019.

This this whole process started in 2019 with Renown Health.

So renown is in Reno, Nevada.

So we took a look at there were a lot of things to this project.

This is not everything, just a few examples.

We took a look at one.

What sort of the distribution of their ambulatory network we knew they had.

They had two campuses, right.

They had a major regional hospital of 600 to 700 beds, and then they had a community hospital a little bit further south from that hospital that had about 100 or so beds.

But then what did the rest of the system look like?

How are the patients accessing renowned health for ambulatory care outpatient services beyond that?

Right.

And where might they want to reallocate facilities or create new access points in the system.

So that was one part of the conversation.

We also took a look at sort of the demographics of the community.

So there's mapping softwares that you can use that access public.

You probably do this a little bit in some of your studio projects.

What's the demographics of the community?

What's the median age?

What is the in migration, outmigration of particular zip codes.

And so we've looked at a lot of different demographic mappings around their two facilities and wanted to understand in migration median age population per square mile.

Just understanding the community.

And what was the drive time from each of their major campuses, from their their regional 600 700 bed facility and then their hundred bed, like what was a 15 minute drive time, what was the access?

How much coverage did they have across the community?

So starting to understand the density of the community and how far away they were from this, from the people that they served.

And then similarly, where were their patients coming from beyond just Reno, Nevada.

Right.

So each of those dots up there represents one patient discharge or admission, right?

One admission, one person who has come to the hospital.

And so there's these mapping softwares out there that will distribute the zip code data.

So where these patients are coming from from a zip code perspective.

So you start to understand okay, we got a lot of patients coming from proper Reno because we have a distribution of people coming from the south by where that big body of water is Lake Tahoe.

Right.

So they're getting and we can look at it by service line.

Are these patients coming in for musculoskeletal issues, neuro issues, cardiology.

So we can we can just chip away at understanding.

And this has nothing to do with architecture.

But the architecture is what supports them serving all of these patients.

Right.

So we did this.

We did a strategic master plan that kind of turned into a facility master plan.

I don't expect you to read all this, but this was a bed need model.

So another layer of this exercise is okay.

So we have this many patients discharges.

You start to look like I was just alluding to you have different service lines in health care right.

Neurosciences, oncology general medicine, maternal child.

We looked at their volume of their inpatient their inpatient volume outpatient.

But this is a bed need model where we said okay, this many this many patients by service line.

They're staying this many days.

That means they have a current bed need of X. So I'm going to make some numbers up here.

We have 600 beds at our regional hospital, but we're needing 590.

We're getting kind of close to capacity that we're starting to feel lockdown.

Right.

Like we're we're in gridlock.

Right.

So and I will say they were starting to feel some versions of gridlock in the movement of their patients in their hospital.

Right.

Because their, their supply and their demand or starting to get in line with each other.

And then another thing we do here is we start to grow each of these.

We grow them in terms of what they think their aspirations are by service line to understand, okay.

They have an aspiration to grow cardiology or they're seen growth in maternal care because maybe there's younger, you know, younger median age.

And so we have family age bearing folks in the community which is increasing that particular.

We can look at it at that level.

So we grow it out.

We grow it out 510 years.

We also look at their market share.

They have other competitors in the market who are serving parts of the population.

Do they think for whatever reason they're going to gain market share, or they might lose it because they're feeling threatened by certain maneuvers that others?

So we're looking at all these things, and it pumps out what may be a future bed need.

That is a really important thing to know as you go into master planning to go, okay, again, I'm making numbers up.

We're a 600 bed facility today and we need about 600 beds.

But in the future we're going to need 750.

Where are these 150 beds going to come from?

They're going to be built on this campus.

They're going to be built somewhere else.

They're going to go somewhere else.

If we don't, if we don't prepare to serve it.

So these are really important, what we call key planning units, right?

CPUs, key planning units.

So we do all this strategic work to then get some key indicators to start to understand campus movement.

So this is an example of an exercise I'm going to spend most of my time probably on renown.

So we can follow up later on some of the other the other projects.

But once we understand bed need by service line, we then have to kind of overlay it on top of their existing assets.

They have existing towers.

They have two existing towers on their main hospital campus.

Three actually.

Where are the patients by each service line in these towers?

Right.

They have a Tahoe tower.

They have a Sierra Tower, they have a rose view tower.

And where do we want them in the future?

And where do we want these new beds?

Right.

So we did pretty sometimes the best tools are your most basic ones.

Post-it notes A big post-it note represented a 30 bed unit, a half a post-it note represented a half unit, 15 beds.

Not every unit in their system was the same size.

Some were 30 fours, some were 20.

But we were just working rough order of magnitude to get the lay of the land, of how they wanted to rearrange service of beds in their facility.

So move these things around.

Start talking about service line relationships, capacity, add yada yada yada.

And then we had an understanding of kind of where we wanted things to go.

These exercises are always living exercises.

What landed that day is not the Bible till the end of time.

It helps them make decisions.

So at the time when we did this, it was right.

During Covid, if you all were paying attention, a dollar didn't go as far after Covid, right?

So we had this master plan that we were going to do all these things, and all of a sudden a dollar didn't go as far in construction.

So we had to come back to the drawing board and say, how do we do what we need to achieve for this community with less resources?

What that brought into the equation was, okay, our children's hospital needs to grow.

We need more NICU beds, neonatal intensive care unit, little babies and we need more pediatric ICU beds.

The youngsters, but not the teeny weeny.

We have to grow our children's hospital, but we can't build a new children's hospital.

They had two shell floors available in their existing Tahoe tower, and so made the decision at that point that they were going to move a great portion of their children's hospital into a shell floor.

It was pretty good.

Size, shell floor gain capacity, grow the abilities of the children's hospital, which is a hospital within a hospital in this case, and that led to an architecture project.

But this was months, years of adapting to how things were changing in the world, staying in a planning mindset and being able to guide the client to start to curate their future.

Right.

And just because it's decided one day doesn't mean that it will.

It will stay like things happen in the world, and then you have to pivot.

And I just took you through a couple pivots.

But this stuck and we took this shelter and we fit it out for one.

One side was the neonatal intensive care unit.

So kind of an open bay model.

They were in pods of force, a little bit of a hybrid model.

And then the other side in blue was our pediatric ICU.

And it was designed to sort of flow because sometimes babies need to be in the pick you and sometimes pick you.

Kiddos are actually NICU kiddos.

And so it's between pick you and NICU.

There's a there's a relationship.

So it was actually kind of nice that they were on the same floor and could flow back and forth with each other.

And the tools that we used in this were very different than the tools I just showed you early on in the strategic planning process, where we're modeling things in Excel and we're run and mapping and we're running drive times, this is totally different decision making right now.

We have a floor and we have to get X number of beds in it.

How can we make the most.

So this is where we start to sit down and draw and lay it out.

And then complexities and contradictions and compromises come into play.

So one of the tools that we often use in the design process is a lean tool called an A3.

The point of an A3 is to very does anybody know what an A3 is?

I want to tell you what you already know.

Okay, so an A3 is look up A3.

It's a paper size, but it A3 is a European paper size.

But the intent is that on an a three piece of paper, you describe very succinctly the problem, the details of the problem, opportunities for solutions, and then sort of a conclusion you can push and pull and make it more complex or less complex than that.

But basically it's what is the problem and how might we solve it.

Right.

So as these contradictions come into play, we use A3 a lot to say, all right, let's get to the heart of the problem.

And what are the possible solutions and what might they cost.

So and is it juice worth the squeeze?

I'm going to make numbers up again.

This solution is $1 million solution okay.

The solution is a $5 million solution.

They basically almost achieve the same thing okay let's go with the million dollar solution.

Right.

So you have to also have to put cost to these things at this point and be able to work with your hopefully you have some sort of design assist at this point or contract manager at risk who can be by your side starting to inform the push pull that happens during design.

So A3 is another tool we use, but this is a different altitude than being upstream and strategic facility master planning.

Okay, so I got through renown in 20 ish minutes, 15 20 minutes before I go to the next one.

I'm just going to ask any specific questions on all of that content I just showed, kind of going through the continuum of strategic planning to programing to early design and say grace through her hand up first.

Okay.

We'll go.

Remind me your name.

Robert.

Robert.

Kind of.

Yeah, I can hear you.

Yeah.

I was a little surprised you mentioned planning for 5 to 10 years out.

That seems to be a really short time frame for a multi-million dollar project.

Why wouldn't you design for 20 to 30 years out, design for 20 to 30 years out, but to forecast more than ten years?

In fact, I think looking out ten years on a forecast anymore in strategic planning is is challenging, right?

I'm starting to see master plans in the forecasting space, not design.

We need to design absolutely for 30 plus years as best we can be sure proof as best we can.

But in forecasting, I'm starting to see clients want to see a 3 to 5 year show me a three, show me a five.

Because 5 in 10 is getting harder to forecast.

I mean, it's like the cone of a hurricane, right?

We can be more specific with the cone.

The closer it is to the now, the further out it gets, the wider the scenarios are in ten years for forecasting in terms of volume projections, is getting to be, you know, the confidence is getting lower with how much the world is changing.

But I agree with you.

We need to be designing architecture as future proofed as possible because buildings are 50 year assets.

So is that.

Yeah.

I understand what you're saying about it being hard to forecast out.

You know, beyond that, it just seems like you could do a linear progression and have it have a good idea, but maybe not.

You certainly could.

I don't know that these administrators are necessarily always interested in 20 years because, you know, they've got their own career timelines and they've got their own focus.

So ten years seems to be like a good horizon for them as administrators to wrap their mind around.

I've not had a C-suite come to me and say, I need to see what 20 years looks like.

So while we could I don't know that I've ever had a client asked me to.

In thinking about that, when you come up with the concept and the design, do you design it in such a way so that potentially if, for example, neurology bed counts decline and pediatric bed counts increase, that you can you can switch some beds from neurology to pediatrics.

Do you build in flexibility.

Yeah.

That project not as flexible obviously.

Right a pick you and ensue.

That's not going to turn real easy to be adult adult supportive.

But that's just sort of the nature of adult beds versus children's beds.

But yes, the sort of best practice right now in medical planning for architecture, particularly hospitals, is universal beds, where you design them in a way that they could become something else, like, for instance, as an example, the codes for an ICU bed versus an acute care bed are not exactly the same.

The headwall clearances are different.

The clearances around the bed are different.

There's there's differences.

But if you were to design it to ICU capability, it could always be an acute care sort of beneath that.

And then if you wanted to turn it into an ICU, I mean, it's more complicated than that, but it's really like all bourbon is whiskey, but not all whiskey is bourbon, right?

You want to you want to be to the most flexible design.

So we are doing that, generally speaking, as best as we can with the dollars that we have.

That's become best practice at this point to do universal beds.

So you had a question, Grace.

Yes.

One more question and then I'll give one more project, I think after maybe 1 or 2.

Quick, quick.

So my question is, I imagine that like the different steps of this project process aren't like cut and dry, move on to the next thing.

So like, what kind of challenges or workarounds do you see when those things kind of start to overlap?

Or like, yeah, oh, like when it's not as clear what you should be doing next.

Yeah.

Like when the I, I assume you're transitioning into the next phase of the project and starting to work on things, but I assume that brings up things talking about the last phase.

And should we change this and what are we doing about that?

Like how would you say you manage those challenges?

I guess I think that's a good question.

Yeah.

This is not the earlier the more upstream you are the the more.

Less clear the process is.

But thankfully a lot of these institutions have what they'll call presidents councils or the or boards.

They have boards as well.

And those are great gateways to the process to create milestones in these in these in a process like master planning and strategic planning, where there's a lot of ideas on the table and you're trying to create scenarios and craft ideal states and articulate a future, you then present it most often to a board.

They may present it to the board.

They may ask you, in the case of renown, I have gone with the C-suite before to help them present these ideas to their board.

A lot of times they'll present themselves to the board, but the board is a governance.

I would say it's both challenging because you have to get ready for the board, but also it's a really helpful tool in the process that says we have to get ready to tell our story real clearly and ask for approval.

And the board has the responsibility, as governors of a system to make the call as to whether the juices worth the squeeze.

Do we have the funding and should we deploy it this way?

Do we want to spend capital this way?

So you prepare these ideas to articulate to them, to ask for their approval, and then if they approve, we go to the next step.

Right.

And then there may be another board approval at some point at a different altitude, which is a really great segue into the next.

Did that answer your question?

Yes.

It did.

Okay.

Yeah.

So I'll go see I'll go for five more minutes real quick.

And this one is actually quick.

So new pediatric campus in North Texas.

This is one of the shareable renderings.

Now I can't show all the tools, the actual tools that we used on this, but I can show you the kinds and flavors of tools we use when we're very early in the development of this project.

In 2022, UT Southwestern and Children's Health had a sense of what this campus needed to be, but we had to work through modeling with them on their volumes and whatnot to to clarify, be they knew the beds and the size of the Ed and the number of.

But then we had to kind of work down the other departments and say, okay, well, those aren't the only three departments in a hospital, right?

We've got cardio diagnostics, we've got neuro diagnostics, we've got interventional radiology.

So let's take what, let's take all that and start to inform the space program in more detail.

So get more, more key planning units established for all the departments.

So that's what this model is an example of.

We have models and a lot of architecture firms and consulting firms and pre-designed consulting practices have different versions of this model where you're running volume against time, open against days per week against utilization rates, to say, if I have this many people that need to be served by imaging, how many machines do I need?

It's really just volume against time.

That's all it is.

And then you take that and it says, okay, you need five MRIs.

All right, I need five memorize, I need ten X-rays.

I need four ultrasounds, whatever it is for imaging for the imaging department.

You then take that information and you start to populate it into a space program that says, okay, for every MRI, I need x number of square feet.

Generally speaking, for every interventional radiology room, I need x amount of square feet for the department generally thinking.

And you get your arms around the square footage of that department.

And then the next step, which we did, is taking our arms around those macro square footage, departmental gross square footages.

If you if you move into healthcare architecture when you start your careers, DGS will become a big part of your world departmental growth square footage.

If you were to draw a box around the outside of the imaging department, that's it's departmental growth square footage.

So then once you have that sort of establish at a benchmark level, you start to fill in the details, okay, if I have five MRIs, then I need this many pre-op areas and holding spaces and offices and care team stations.

And you get real again altitude change.

Right.

Like we're changing altitude.

We're getting into more detail.

So we did all of this with with the new pediatric campus in around 2022 2023.

Fast forward, you can follow this project on the internet.

It's being dug out of the ground.

It's starting to go up.

Right.

So it wasn't that long ago we were making some relatively high level decisions that then led into architecture and design and is now in construction.

And then I'll give you a quick flash.

This is a project out of our Houston studio at Perkinson Will.

It is very much out of the ground.

This is a rendering, but it's almost of this scale in real life right now.

But the skins, I don't believe the skin is quite on, but about a 750,000 square foot building on the MD Anderson campus where this is.

This is support services almost exclusively in 750,000ft², a lot of lab space, a lot of clinical support.

And it connects with lots of bridges to other buildings on the MD Anderson campus.

So really complex piece of architecture.

So another part of the continuum, I'm not going to take you to the early days, because I certainly wasn't a part of that on this project.

But what we have to work through is, okay, so we know the building needs to be this big again.

Here's a stacking diagram.

How does it relate to the other buildings on campus?

What should go where?

What are the horizontal and vertical relationships that we need in this building.

And we need to other buildings.

Right.

So stacking diagrams very important decision making tool.

So.

I'm going to click through.

They have some other tools they use at MD Anderson S bar is from the MD Anderson sort of culture where you define a situation, give it the background, assess it and make a recommendation.

It's very similar to an A3, right.

What I just described about an A3, this is sort of their flavor, an S bar.

Great tool for making decisions.

It's just a quick question just about how much a square foot is this particular building.

Good.

How how much is the cost estimate per square foot roughly?

We're talking about a lot of different functions.

So in Texas, $1,000 square foot in San Francisco, Northern California, right now for a complex urban site, I would say I would be planning around 1000 right now, plus or minus in San Francisco.

Right now, we're seeing projects that are 1800, $2,000 a foot.

So so the total in the hospital one might be how much?

Oh, I can't I can't quote you on that because it was probably priced a while ago.

And now it's past the midpoint of construction.

So you get an idea.

It's more than pennies a day.

Okay, well, I think you make a really good kind of concluding point here to at least my presentation.

Part of this is that the decision making that you will make with health care administrators in this line of work, whether it's the C-suite or it's a real estate EVP or it's a director of construction, every square foot, depending on what part of the country you're in.

But let's just talk about our part of the country is getting to be $1,000.

This is $1,000.

Decisions have to be well informed, right?

Plus your operating costs.

I'm not getting into that.

So and don't quote me on a thousand.

There's a lot of is it an outpatient building.

Is it a medical office building.

Is it business occupancy versus institutional?

Is it in a downtown complex site?

Is it out in beyond the suburbs, in a new part of town where it's easier to access or there's less construction trades?

Right.

There's a lot of detail behind the cost per square foot, but generally complex buildings that are institutional 1000 bucks, 2000 in Northern California.

I mean, it's these are these are important decisions because 750,000 of these.

So I think that's probably enough.

What I wanted to share with you guys today before maybe we just discussed and talked through it a little bit more, is give you a sense of that of how you land these planes, right?

It's different in different parts.

And you may find as you start your careers that you're really suited for this part of the continuum, or that you're really suited for the part that I have lived a lot of my career in that you can, you have you have breadth where you can kind of carry a project all the way through, or you may be able to, but you don't want to, right?

You're going to learn as you get in and you get involved in things that we're all a part of the decision making process, and it's our clients that we have to lead to making decisions that they're confident in.

So it's our job to lead them to making confident decisions about their future.

So I think that's what I'm going to wrap on.

Well thank you so much.

Yeah.

Yeah.

Thank you.

Yeah.

And we have a good amount of time for Q&A.

So students, I know that some students joined us later during the lecture, and there are some students from my healthcare design studio present here as well.

They're working on a mental and behavioral health project.

Do you guys have any questions for Ashley?

I've got one more from Robert.

So back in the day, I went to a facility like this in Houston for my medical school interviews.

And and it was frustrating because honestly, it wasn't very well organized.

And I, I had three interviews and I was late to all of them because I couldn't find the room.

Yeah, TMC is complex.

Yes, yes.

And I, I just wonder, you know, from the perspective of, of someone possibly a. Family whose lower socioeconomic status I can see a facility like this being very intimidating and, and I, I just wondered if there's, if there's any discussion about.

About a different concept for facilities, for example, smaller satellite facilities that might better serve populations that would find something like this very intimidating and possibly so much so that they might visit once, but they might not be inclined to go back because the experience just wasn't the best.

And I wondered if there's been any discussion about that.

Yeah.

Wow, that that's a fun one to dig into.

By the way, this is not a building that patients will come to.

This is a support services building.

But there are so many buildings in the Texas Medical Center in Houston that are of this nature.

And it is very intimidating.

And I know all of the systems that are in the TMC are having these conversations.

And I know in particular, MD Anderson has what they call Hal's Houston area locations and starting to in fact, we just designed and helped them open an imaging center on the outside, kind of in one of the suburbs.

If we get the one that we were, what city it was exactly.

I want to say it was around Missouri City.

So suburb of Houston, right.

So they're grappling with this.

How do we provide access, get the quality of care that these patients need in a more convenient way, distribute drive times?

Again, back to the drive times that I was suggesting that comes into play.

Like, how far are these folks from Sugarland having to drive to the TMC for an MRI?

Right?

Like that's why that early planning is really informative to them, deciding where to put architecture or where to shift activity to a new piece of architecture.

I love that space.

I have so much enjoyed my career in that space because of these questions.

Relatedly, but more about the architecture.

I know our company, Perkins and Will, and some of our competitors as well have a service line for experience design, because experience is a huge part of the patient journey and experience has impacted by how we design our architecture.

And so we I'm kind of the collective we in this room are architects, right?

We're thinking about experience.

Well, experience designers are thinking only about experience.

And so it's this sort of if you have an experienced designer on your hip as you're designing, it's a really powerful combination of professionals.

You're thinking about space and requirements and experience, but they're thinking about experience.

And okay, a little bit about space.

Like what a great combination of professionals.

And we have clients that are investing in experience design services because of everything you just articulated.

These are these can be intimidating.

They can be hard to access in certain parts.

Certain campuses like the Texas Medical Center.

How do we make it a positive experience when you're dealing with a difficult time in your life, which most often is the case in healthcare, except for when you're having a baby.

Most of the time, that's like who anyway?

Yes, that that.

I would love to dig in more on that if we had more time.

But I'm mindful of when are we done?

Done here.

So around 130, around 130.

So we got ten more minutes or so to visit about things.

Any any other thoughts or.

Yeah.

Go ahead.

We have one question for him.

Yeah.

Okay.

Yeah.

Whoever.

So since the future is so unpredictable when you forecast the next 5 to 10 years, are there any like common challenges that you face across like the projects that you've worked on?

Forecasting is is challenging and it is forecasting, right?

We don't none of us have a crystal ball.

I think what's helpful and you don't just do this, but what is helpful is to look at and I always ask for this is the last three years.

So I can see a trend over the last three years.

That doesn't mean you just take it and apply the trend of the last three years of how their volumes have changed.

You don't just apply that just like I mean, you could to get a sense of scale, but you you have to start having conversations to be able to, to have a better view of the future, which none of us really, really know.

But we want to do our best.

It's about having conversations with the administrators, the division chairs of what their aspirations are.

Are they going to be recruiting a lot of physicians, which is going to catalyze more volume?

Because with physicians comes volume and access to the system.

So you have to ask these very detailed questions so that you inform the future.

I don't know if I'm exactly answering your question, but the challenge is not knowing it.

Right.

So the best we can do is ask really good questions.

And to surround our modeling with data, historical data, aspirational data.

That is, we want to grow this service line and we're hiring three more physicians.

Okay.

That is helpful to our modeling.

In my mind, it's not just math in those models.

And that the slide that you couldn't read, that was the massive bed need model with all the cells.

Every time you move a dial in a model, you have to have a reason you can game these things.

You know, I'll change this dial, change that doc to get it to say what you want.

It's math.

You can make it go up and down, but every time you make a change in a model, you have to have a reason that's informed by what the client is telling you so that there's confidence in the model.

Right?

It's believable.

And we go, okay, we can choose to invest in this because we feel like the things that we have expressed qualitatively are quantitatively modeled.

So reason you have to have a reason for every model move to hopefully move towards you start marching towards a future that you believe and manifest.

So actually, just speaking of the models.

So I noticed that you had a programing tool and there were some computer based simulation tools that you're using.

Are these the tools that Perkinson will develop or are these tools that are freely available, available on the market and students can use?

I don't know that they're freely available.

You come join Perkins and Will and you can have access to them.

One of those models, the green one.

I could flip back to it real quick.

Probably it's just algebra that there it is.

It's really just algebra into a fancy Excel with radio buttons and what like it's just behind that.

It's just algebra.

And again, it's not just math.

You could think it's just math, but every move is you don't just say that an imaging department is open for 12 hours.

You ask them, what are your operating hours?

Okay.

You're open Monday through Friday from 7 a.m.

to four.

Or are you serving patients during the lunch hour?

Yes.

Okay.

You're open on Saturdays all day Saturday.

Just three hours in the morning.

Okay.

Right.

Like, it's just algebra, but it's informed by their inputs.

So this is this is not publicly available.

But it's not rocket science.

But we do have some more rocket science stuff coming along that we're starting to use.

I think it's really interesting.

It doesn't take us out of the facilitation of a project.

I'm going to bounce forward real quick, but it makes us move quicker, which seems to be what the world is intrigued by, right?

Why do we like AI?

It's helping us do things quicker.

This is an app that we have developed called Campus Planner, and it starts to aggregate a lot of the tools that I showed you that I can run on my own, or I have my own little version of that I run for my clients.

It starts to aggregate them all into a dashboard that's web based, and we can start to put all this information.

And if we change the cost per square foot on this scenario and this stacking, that puts a stacking diagram with a map with square footage and program data and cost per square foot, and it's all in one place.

So we're still a part of the process because we still have to facilitate our clients.

But it can be quickly updated where you don't have to go.

Like, let me go back to the studio, update my Excel, get back with you next week.

We still do that because the world does.

Still a little bit kind of have to bake.

You got to let things bake in the oven.

Sometimes going faster is not always the best.

People have to sit with things sometimes, right?

So even if you can't go fast, it doesn't mean that decision is going to come quicker.

You got to have oven time, you know, you got to have oven time to kind of come around to decisions.

But being able to answer questions quickly so people can sleep on things sooner is helpful.

So this is a tool not available to the students.

But I would gladly get on the phone with any of you guys to share some of this stuff that you can build your own, right?

This is just a lot of this is Excel based or power BI.

You're all really smart.

I know in the technology realm.

I'll talk to you about what it is so you can maybe create your own way.

Like I said, come join us.

So is that answer your question a little bit.

Okay, cool, cool.

And let's see if we have any other questions from students before we move to questions from faculty and other members.

Did I bore you semi interesting.

Okay, I'm getting a semi interesting vibe from the room.

Cool.

Okay.

We have one more question from Robert at the back.

Here.

As soon as he has.

Is it good?

I'm glad you're not.

Yeah.

Can you talk about some of the design features that are unique to a pediatric setting versus an adult?

What's really different impedes from adult care is not just how it looks.

Obviously, it's going to look different.

We want an appeal that's fun for the kiddos, but it's child life.

A lot of child life components come in, and so those units or those clinics may be larger.

On an inpatient unit, for instance, we see teen rooms, we see little kids rooms, we have sea theaters.

We you know, there are components that let kids still be kids, right?

And we don't really need those in adult care.

Right?

Like, give me my privacy, give me a space that my family can come visit me, give me a little access to outdoors, right.

So I can get some fresh air.

But for kids, they're growing up there developing.

We have to be able to teach them still when they're in the hospital and in the clinic environment.

A lot of times what happens when kids are in clinics?

They're going for just a regular old doctor's visit is their siblings are in tow, their mom is towing them and their siblings.

So we have a little bit there are more people coming to an exam visit for a kiddo usually, than for an adult.

Okay, I got a doctor's appointment.

I'll take myself.

Okay, so we have to have a little bit more appreciation for the waiting space, the queuing space, the egress.

There's just more people coming and more stuff.

Bags, strollers, toys.

So it's general space and it's child life, I think are the categorical answers to your question.

And that's what I think is really compelling about it.

Pediatric architecture, which I've been lucky to be a big part of throughout my career, is just one.

Kids are so resilient.

They are so resilient.

Any kiddo I've seen in a hospital through my projects, when you're touring existing spaces or whatnot, they are so resilient.

They're so happy.

They don't let what is a horrible situation in a lot of cases get them down right.

And we want to foster that resiliency as much as we can.

So providing spaces for their teaching, their socialization, their play play is so important.

Frankly, I'm not sure why we give it up when we get older because it is so good.

So that's the difference.

Yeah.

And it's a really inspirational type of architecture.

Yeah.

Thank you so much.

So who here is going to go into healthcare architecture.

You think once you get into the real world possibly.

Possibly.

Okay we got some pretty strong interest.

Yeah right on.

You will not be bored and you will always feel fulfilled because it is a very purpose driven field and it's absolutely impactful.

Yeah.

And challenging you.

That is true.

Yeah.

You will keep the brain ticking.

So Grace, you have one more question.

Yes.

If there's time, there is I think so you have two minutes okay.

So what would you say is like the biggest difference if there is one when you're like doing a renovation project?

Because I know most a lot of healthcare projects these days are.

Yeah, renovations.

Is there like a different starting point versus a new build?

Oh yeah.

Very, very different types of projects in renovations.

I think the best first step is understanding existing conditions.

Poking your head up into the ceiling, seeing what's going on up there with your engineers, understanding the floor to floor heights.

Because if you only have so much floor to floor height and you're wanting to shove in or or procedure room in it, you have a lot of things that are going to go above the ceiling.

Do you have space for that?

Existing conditions, survey due diligence.

Getting your engineers involved with you very early is so important in renovations, greenfield projects or new construction.

Different kinds of early challenges.

You know, you have you have kind of more or less an empty canvas that's challenging in its own way.

We have so many ways we could do this.

We could chase so many different ways of doing it.

That's not the case of renovation.

A lot of times the constraints start to expose the pathway because you have to reconcile all these existing constraints.

The challenge for new construction.

The world is our Auster, or at least you feel that way early.

Early.

So.

Well, yeah.

Okay.

Thank you so much.

Thank you guys for having me.

It was a wonderful presentation.

Thank you.