Question: What are some healthcare design solutions that stand out in your career as being groundbreaking, either personally or for the communities in which they were applied?

Rebecca: There are two specific "ah-ha" moments in my career that have personally impacted the approach of design for the communities we serve. Each of these stems from the guiding principle that solutions are based on their value to our client. We provide option sets and they make decisions based on value.

The first learning is that there are no magic bullets-one solution does not fit all. That may be obvious, but as designers, we are typically asked for the most innovative design concepts. These innovative concepts need to be rooted in organizational dynamics values, culture, and community demographics. Our first order of business is to provide our clients with solutions that tie back to their community and values, and these are different for everyone.

The second learning is that design is about the patient experience. I have realized that designing a healing environment for patients, their visitors, and for staff is a win-win. Patient-focused care is not only the right thing to do; it is been demonstrated to be cost-effective. That will be even more important as we move toward healthcare reform. It is truly about the patient experience, not provider convenience or departmental silos.

Question: When doing healthcare renovation work, such as with the Martin Luther King Jr. Medical Center, what are some of the most striking indicators of old design thinking?

Rebecca: Several things come to mind. One of the most striking indicators of old design relates to the design impact of the full implementation of electronic medical records. As examples, there are traditional spaces, such as Health Information Management (Medical Records) and Patient Admitting and Registration that have changed substantially. These functions are still necessary, but the location, amount of square footage, and relationship to the patient have changed. As a case in point, admission and registration procedures are largely performed before admission for elective patients. Information is then verified upon arrival. Patients that are unanticipated are admitted and registered at the bedside, either in the treatment room or in the hospital room. The need to look at the design implications of telemedicine is very important.

Of most significance is the need to investigate the use of space for multiple purposes versus silos of operation. Some examples of functions that can be co-located include treatment for pre-operative patients, emergency department treatment in times of patient overflow, pre-procedural testing, and outpatient infusions.

Question: In what areas of healthcare design are the rules being broken the fastest? What aspects of design are changing most rapidly, and what benefits are we seeing as a result?

Rebecca: Technology is at the root of out-of-the-box thinking. It allows us to challenge traditional design and old rules of thumb. Telemedicine is one example, as the technology allows a patient to remain in the same private room environment, whether they need ICU-level care or are getting ready for discharge.

Telemedicine also gives a physician intensivist the ability to support the care of a patient who is critically ill in a rural setting, and in so doing, significantly contributes to a positive patient outcome. (The Society of Critical Care Medicine has documented a reduction in mortality rates.)

There are benefits of hybrid operating rooms that provide diagnosis and treatment, acuity-adaptable patient rooms, universal care shared spaces, and more transparency to the consumer.

Question: What will the healthcare design landscape look like 10 years from now?

• Healthcare delivery will be based on outcomes that are measureable and focus on the patient experience.
• Patient care will move closer to the home setting vs. the hospital setting.
• Technology is changing rapidly and will support the patient experience and positive outcomes (i.e., reduction in medical errors and an increase in accessibility).
• Healthcare organizations will dedicate valuable square footage to revenue-producing functions and to critical patient care necessities.

Question: Tell us something interesting about yourself.

Rebecca: Though I work for an architecture design firm now, my background is firmly rooted in hospital administration, including time as CEO and COO of Scripps Hospital Encinitas in San Diego. I'm also a registered nurse, and it's with this unique perspective I'm able to work with design teams and healthcare clients to advocate for patient and worker safety, while also helping to enhance their operational efficiency.