Designing Innovative Healthcare Centers: Architectural Design

Healthcare is fundamentally a scientific pursuit, from clinical skills to cutting-edge diagnostic testing. Medicine is also an art, and art plays a vital role in the success of patient care. Once such element of art is where healthcare is delivered. Physical structures can affect a patient’s experiences and outcomes. Host Mike Sacopulos discusses this topic with Sharon Woodworth.

Woodworth’s career path that led to architecture is an inspiring one, and she is known for driving change in operations and care through design. Hear her thoughts on design of outpatient facilities, designing to retain healthcare providers, how design can support “lean” operational models for staff, and trends for the future.

This transcript of their discussion has been edited for clarity and length.

Mike Sacopulos: My guest today is Sharon Woodworth. Ms. Woodworth is an architect who specializes in healthcare facilities. She planned more than 11 million square feet of healthcare space. Sharon Woodworth, welcome to SoundPractice.

Sharon Woodworth: Thank you. I'm so glad to be with you and everyone who listens to you.

Sacopulos: Well, thanks so much. I've been excited to speak with you for quite some time. This is a little different topic than what we normally handle on SoundPractice, so it's very interesting to me. Let's start, though, with the career path that led you to being an architect specializing in healthcare facilities.

Woodworth: Well, Mike, I'll make it short. I've had four careers, starting as a nurse and wanting to take that reward of caring for patients to caring for the spaces where the patients live and see patients. So somewhere in graduate school for architecture, I did architectural writing, so I was an architecture critic after being a nurse. And writing does not pay very well, so I moved to the West Coast and became an architect. And my fourth career was one of my clients approached me about teaching at University of California in San Francisco, the medical school. So, I teach in the graduate division for doctors, nurses, and clinicians who want to be leading a healthcare institution. And that class is Healthcare Architecture 101. So those are my four careers.

Sacopulos: Fascinating. When I first started today is used the term “healthcare facilities.” Are we really talking about hospitals or is that term for a more expansive category?

Woodworth: Generally, it is just hospitals and/or outpatient clinics. But in the full spectrum of the world, healthcare architecture encompasses first the education, so the medical education, nursing education, or biopharma education. So, there is that education component that's important to healthcare architecture.

At the other end of this spectrum is research: the research spaces that lead either to the procedures, the tools, or the drugs for delivering healthcare. And the traditional hospital outpatient is in the middle of that spectrum. But there is one building type that covers all three and that building type is known as translational medicine facility. You'll have a vivarium hidden in the basement. You'll have research labs on the top floor, and you'll have patients on the ground floor seeing clinicians and being able to look up and see the research. And you'll also have an auditorium for teaching. So translational medicine covers all three in the healthcare architecture spectrum.

Sacopulos: That is fascinating. I did not know that term. As you know, medicine's both an art and a science, and it seems to me that architecture is a blend of art and science as well. Can you tell me about the artistic component to your work?

Woodworth: Oh, honestly, to be frank with you, I think when you're an architect and you tell others in the world that you do hospitals, they have a negative impression because no one wants to go to a hospital, right? Or even see their doctor. So, I think as healthcare architects, we work so hard at not just the beauty of the space, but the comfort and safety of that space. That's where the artistic side comes in. We do all we can to make that first entry into the building a welcoming entry. That might have to do with natural light or the size of the space, or it might have to do with having a piano in the lobby. So, there are different ways for that artistic side to come about.

Sacopulos: You mentioned a piano, which makes me think a little bit about interior design. Is there an interaction between interior designers and architects? Do you work with interior designers who specialize in healthcare facilities?

Woodworth: Absolutely. Those unique individuals are the ones who determine what the patient sees and what the patient touches. Because when you walk into a space, the healthcare architect has shaped the space. They've given it a width, a height, a depth, and they've given it a number. They've repeated it like the repetition of exam rooms or patient rooms, but all of that is nothing but a shell until the interior designer comes along and picks the color, the artwork, so those things that you see. And they pick the things that you touch, be it the fabric of whatever you're sitting on. Sometimes it's even how the number of a room or the name of a room is done. So yes, interior designers, that's your first impact for a patient.

Sacopulos: And at what point in the process do they become involved?

Woodworth: The earlier the better. Once the program is set in place, the interior designer needs to be involved in how the space is filled. It is up to them, outside of the medical equipment.

Sacopulos: All right. So, I know that you've been in your career for a while and it seems to me that architecture has been at least historically, predominantly a male profession. Has that changed over your career?

Woodworth: We're still just under 50% of the profession. But I will say that in healthcare architecture, there are more women in healthcare architecture than in the other specialties of architecture. And even more interesting, our healthcare clients often tend to be women. And I'm not talking about the nurses, I'm talking about the healthcare leadership. That may not be true for physicians, but healthcare administrators, we're seeing more and more women. So, our clients are more female, and the architecture profession in healthcare is becoming more female. We're still just under 50% though.

Sacopulos: Very interesting. And does it impact how you practice your profession, whether you're working with a male or female client?

Woodworth: No one has ever asked me that question before. So let me think about that.

Sacopulos: There may be a reason that question's not been asked. May not be a good question but, go take a swing.

Woodworth: You know what I've discovered? It takes both. This is a generalization, but you're asking a general question, so I should be fair.

Sacopulos: Absolutely.

Woodworth: So, in general, men like to fix the watch. They like to tinker with those details, whereas women like to understand, okay, once that watch is working, why are we doing it that way? So, it takes both. It takes one to understand the architecture pieces that come together, and it takes the female to understand now why are we coming together in this way? So, it's the architecture versus the operations, and it takes both for it to be successful.

Sacopulos: You've obviously worked on lots of healthcare facilities and seen many others, I imagine. In your professional opinion, what are three factors that make a superior healthcare structure?

Woodworth: Well, healthcare is constantly changing, right? We're learning new diseases and in response to those new diseases, we're developing new tools, imaging equipment or surgical equipment, or we're developing new drugs. So, because of that constant evolution in healthcare delivery, the number one most important thing for a healthcare facility is flexibility. So, you can't customize too much.

And if you're asking for three things, we would all want more natural light, not just for the patient, but for the staff as well. If it is a hospital, they're there 24/7. And if it's a clinic, they're still there way before the sun rises and after the sun sets. So natural light, every opportunity we can get for natural light.

And then third, honestly, this is just a personal thing. I think aesthetics are important. I do like art, and art might be something visual, a painting or a sculpture, or it might be something interactive or it might be something you hear like when I was talking about the piano in the lobby, or it might be a performance, helping the patient work through a play so that our art aspect, in my personal opinion, would be the third icing on the cake.

Sacopulos: Your first point had to do with flexibility, which leads me to my next question. Are your structures designed/built with a specific life expectancy in mind? If so, what is that life expectancy?

Woodworth: I don't know why this came about, but traditionally we've always said, "Oh, it's got to last 50 years." And yet as healthcare architects, we sometimes end up working on facilities that are still in operation beyond 50 years. We see hospitals that are 80 years old and still in operation. But COVID taught us that 50 is too long. That hospital, yes, it's got to last 50 years, but it's got to change within a matter of weeks when a condition like COVID comes along. So, whether it lasts 50 years or not, whether that's the lifespan, within that timeframe, it's got to constantly be changing. I don't know if that answered your question.

Sacopulos: I think it did. So many places I see you can identify where the healthcare system or hospital is in most towns by where the crane is located, right? It always seems like there’s lots of construction in healthcare facilities. Are many of your projects reworking existing spaces or adding onto as opposed to just a de novo project?

Woodworth: To answer your question, yes. Most healthcare architecture today is renovation. And there's a couple of reasons for that. When Obamacare was passed, healthcare facilities were required to start investing in digital. That was an extraordinary expense for a healthcare institution. It's an extraordinary value to all of us. But we did see revenue start going down, so it was more difficult for institutions to just wipe the slate clean and build a brand-new facility. So those are the rarer facilities.

The other hit to the healthcare industry for revenue, of course, was COVID. And so that just added to this constant evolution of we're going to renovate what we had. In the 1980s, the big change was investing more in DRGs. And so, we started seeing more services being delivered no longer in a healthcare hospital setting, but in an outpatient setting. And again, going back to 2008, Obamacare being enforced in 2014 and COVID, we're now seeing not only renovation of hospitals, but renovation of outpatient facilities. That's the dominant market.

Sacopulos: You've spoken a little bit about COVID, and I get the sense that it has been a bit of a game changer in healthcare architecture. Could you tell me a little bit more about that?

Woodworth: I'm going to exaggerate, but in my opinion, no one on this earth ever thought about the building until COVID told us, "Oh, by the way, you've got too many people packed in one space and you have no fresh air. Now what do we do?" And that happened at a worldwide event. So, people started paying attention. I also saw it, there was a very clear line in the sand, the students that I'd been teaching from the year 2012 up to 2020, they totally got why they had to take a class in healthcare architecture.

Sacopulos: Very interesting. What percentage of healthcare architecture projects have a meaningful landscape design component? And is landscape design different for healthcare structures?

Woodworth: Oh my gosh, Mike, I wish I could give you a percentage, and I'm afraid to say if I did the math landscape in healthcare facilities would be under 1%, but don't quote me. I mean, I'm just totally guessing here. It's not nearly as much as it could be. The issue isn't so much “is landscape for healthcare architecture different?” The issue is more the driver of a healthcare facility doesn't allow a campus for healthcare landscape, if that makes sense. Sure, some facilities go to the trouble to create a roof system that allows some outdoor access because they don't have it at the ground level. But that honestly only works in parts of the world or the United States where you can go outdoors 24/7.

I personally have had one facility. It was a small clinic, about three stories tall, two wings, and we, we meaning us and the client together, wanted landscape to be the focus. And we hired a lovely Japanese landscape architect, never done healthcare before, and he suggested that we take the two wings, close them in together, and then split the wings with a river of landscape. And I'm telling you, it is beautiful. Every waiting room in all the clinics looks out on this little river of landscape. So when you can pull it off, it makes an enormous difference for patients and staff.

Sacopulos: Very nice. So, Sharon, as our time together draws to a close, I'm interested in your thoughts on future trends in healthcare architecture. What should we expect to see in the years to come?

Woodworth: Can I ask you, Mike, what do you think I'm going to say in response?

Sacopulos: One of the good things about my position as a podcast host is I don't have to know much. I just have to have a curious mind, and I don't have a good idea as to what you're about to say. I know what I would like you to say, but I don't know if it's accurate or not.

Woodworth: Okay. Can I give you a clue? I mean, what's the hot topic right now in the world? Don't name the war. ChatGPT, artificial intelligence. It is rapidly entering the healthcare industry. We all know, or we think we know, are seeing artificial intelligence for diagnosis. But as healthcare architects, what we're seeing is a rapid way to program either a hospital or a research lab or an education institution, how to program it within a matter of minutes instead of months, and program several options and then turn around and take those program options and generate, I'm not exaggerating, thousands of building options that the client can then choose from.

And it's based on data, not just old benchmarks from the 1950s. Every time you do anything with your credit card or your cell phone, you're giving someone data. And now in healthcare facilities, when you walk into a room, that data is being collected. How many people are in the room? What's the temperature of the room? What's the activity of the room? And all that data, Kaiser in particular, is looking at changing the healthcare architecture delivery process based on the data that they are learning about each one of their facilities across the United States. So artificial intelligence and data will change our world.

Sacopulos: Will it remove some artistic component to the profession of architecture?

Woodworth: I don't know. I hope not. I hope, you know what they say, "it'll free us all up to then focus on what we really want." So, we'll see. It's just now beginning. I think that's the hope that we have. It allows us to not waste time on things, to be able to focus on what is really needed for the client and their patient population.

Sacopulos: Fingers crossed.

Woodworth: Fingers crossed.

Sacopulos: My guest has been Sharon Woodworth. Sharon, thank you so much for having been on SoundPractice.

Woodworth: Thank you. It's been wonderful.

Sacopulos: My thanks to Sharon Woodworth. Her structures provide comfort and support to thousands of patients and family members every day. We all deserve to work and be treated in buildings designed to make lives better.

Listen to this episode of SoundPractice.