FRIDAY Four M.Arch Students, Janelle Eastman, Rojer T.C., Angela Liu, and Yash Salian, were selected to participate in the student charrette at the HCD Healthcare Design Expo & Conference in Indianapolis, Indiana. Their 48-hour experience began with a site tour of the IU Health Campus. Later, they began to work diligently on their project. The remaining A+H students visited the workroom to support their fellow classmates.
SATURDAY The student charrette team presented their project at the Mid-term Review, eagerly seeking feedback from a panel of design professionals. This interaction with experts fueled their motivation, and the students spent the entire day refining their project.
SUNDAY The student charrette team presented their projects in an informal setting at the AIA-AAH Reception / Celebration, sparking engaging discussions with other school student charrette teams.
MONDAY The experience concluded with the student charrette team presenting their final project at the AIA-AAH STERISStudent Design Charette Presentations. The team was privileged to work alongside esteemed faculty Lyndsey Deaton and David Allison, who guided them during the process. Overall, it was a challenging yet rewarding experience for these students. Their hard work and dedication resulted in a strong project. Ultimately, they have gained valuable skills from this charrette experience that can be applied to their academic and professional work.
First year A+H students are very fortunate to have the opportunity to work with local businesswomen Amber and Alex Arnold to provide programming and pre-design services for a freestanding birthcenter and luxurious postnatal retreat in Greenville, SC. This culturally sensitive and inclusive space is centered on healthy and supportive bonding experiences for new moms and their babies.
Working under the guidance of Architect and Assistant Professor Lyndsey Deaton, PhD in the practicum-based course Programming and Predesign we will learn how to work with real clients on a real project! Each student will contribute to the team and to the project in a specific role, providing valuable experience in professional teamwork. We started by conducting research through project precedents, interviews with medical professionals and hospitality specialists, and surveys with pregnant women and new moms. As shown in the images above, we analyzed a few plots in a local planned development and recommended a site. Next, we will plan and facilitate a design charrette with project stakeholders including investors, practitioners, and pregnant women in March. Finally, we will compile all of our research and design recommendations into a Program of Requirements.
We are grateful for this opportunity to work with a local client and contribute to such an exciting new project in the Upstate community!
The Architecture + Health program was fortunate
to have the opportunity to travel to New Orleans, LA to attend the 2023 HCD
conference. In addition to attending the HCD Conference, we were also able to
see the National Memorial for Peace and Justice in Montgomery, Alabama, meet
some wonderful alumni of the A+H program, and tour two inspiring hospitals as
well as the HKS Atlanta office.
Our first stop on Thursday was the Northeast
Georgia Medical Center, where we had the opportunity to tour the mechanical
spaces and learn about the mechanical systems that enable this hospital’s energy efficiency. In the evening, we were
joined by alumni Chenyue Yuan for a wonderful dinner.
We began our day on Friday with a wonderful
experience touring the HKS Atlanta office. The team was hospitable and the
office was beautiful, and it was a great experience to get an insight into such
a respected firm in healthcare architecture. We are so grateful to our A+H
alumni and the whole team for their hospitality, and for taking the time to
share some projects and experiences with us.
The National Memorial for Peace and Justice
aims to create a space to for people to gather and reflect on our nation’s history of racial inequality in a sober and
meaningful way. The memorial is constructed with over 800 steel monuments, each
representing a county in the United States where a lynching occurred, and the
names of victims are engraved on the columns. As we explored this deeply moving
space, we experienced the power of architecture to express grief and memory,
and to inspire change.
On Saturday, we had the opportunity to tour the
New Orleans Children’s
Hospital. This was a valuable and wonderful experience to expand our
understanding of pediatric hospital design. It was a great privilege to have
this tour of such a beautifully designed facility.
On Monday night we were joined by over 50 A+H
alumni and had a fantastic time meeting and reconnecting!
We had three wonderful days at HCD, attended
many extraordinary lectures and seminars, connected with many inspiring people,
and returned home looking forward to implementing some new ideas into our
projects. We were able to be present for presentations from Clemson Professors
David Allison, Anjali Joseph, Dina Battista, and Vincent Blouin. Several A+H
alums were recognized for exemplary contributions in healthcare architecture.
Congratulations to the following A+H alumni who received recognition at HCD 2023!
Presentations:
David Allison
Anjali Joseph
Dina Battisto
Vincent Blouin
Anthony Asher
Christian Bormann
Scott Meade
Kimberly Stanley
Deborah Wingler
Kirk Hamilton
Walter B. Jones
Frank Zilm
Asma Sanaee
Shan Jiang
MillerKnoll:
Madilyn Dubois
Cassidy Bland Roberts
Tuttle Fellowship:
Sara Kennedy
GMZ Fellowship:
Swati Goel
2023 Healthcare Design Awards:
Kenneth Webb (HKS)
Kimberly Bandy (ZGF)
David Allison
Anjali Joseph
HKS Atlanta
alums:
Thabang Nyondo
Les Saunders
Hannah Shultz
Ethan Hopkins
New Orleans Children’s
Hospital:
Sarah Wade Walter
What an incredible experience, and a truly
unique opportunity for us as students to attend a trip like this. We are
sincerely grateful.
The No Place to Play exhibition focuses on specific findings about gender taken from a large research study with the same name. The larger study was conducted by Dr. Lyndsey Deaton, a Professor of Architecture in the Architecture + Health program at Clemson University. The project links economic development policies to social inequality in gentrifying communities in South and East Asia by highlighting how spatial changes affect teenagers’ mobility and access to public space. The forthcoming book (2024) is written for concerned parents, policymakers, designers, and community advocates. In it, Dr. Deaton describes five years of living alongside seven dispossessed communities and builds a case for contextualized, community-driven design.
Dr. Lyndsey Deaton Opening the show
The exhibition was designed and constructed by a group of Clemson University students from a variety of majors including architecture, psychology, women’s leadership, and sociology led by Dr. Deaton. It is an artistic demonstration of the influence gender has on teenagers’ access to public space in post-displacement communities. The exhibition highlights 50 teens from seven communities in India and the Philippines. Walking through this exhibition, visitors will hear recorded conversations with teens and see maps and photographs they created to better understand how displacement affects teen socialization. Finally, join our team of Clemson students in considering the similarities between the teens’ experiences in this study and the urban public spaces around South Carolina.
Exhibition Window PlacementWhere the Third Place is
Maternal care was an early clinical interest for me and this interest inspired me to pursue nursing so many years ago. As a student in the certificate program in Leadership and Innovation in Health + Design at Clemson University, I am enjoying studying the connections between healthcare policy, nursing and the design of the built environment. Last semester, I had the opportunity to undertake research on an area of public health policy and explore its connection to the built environment. I chose to study maternal mortality and morbidity and its relationship to the design of the built environment. In conducting the research, I was saddened to see the trends in the U.S. and feel called to do what I can in my new career, blending my extensive experience in healthcare with planning, design and construction to make a difference through the built environment.
I learned that the maternal mortality rate in the U.S. has risen consistently since data collection began from 7.2 deaths per 100,000 in 1987 to 17.3 in 2017. The maternal death rate exceeds that of 40 other countries and the U.S. is one of only eight countries worldwide and the only developed nation where maternal mortality has actually increased over the past three decades. Additionally, for every maternal death there are estimated to be 70 cases of severe morbidity, and many more near misses that are not quantified. With up to 60% of maternal deaths being categorized as preventable, there has been heightened interest in the clinician, patient and institutional factors that contribute to poor maternal outcomes, and to identify potential areas for intervention.
While there is a large body of literature outside of obstetrics linking care environment with patient outcomes, there is limited research on the impact of the physical environment of obstetric care on maternal morbidity and mortality. What I did learn from the limited research found on birth environments, is that there are three important built environment themes which promote normal physiological birth processes, influence the need for medical interventions, and effect cesarean section rates. The three areas that architects, clinicians and healthcare administrators should consider for design and research in birth settings are the overall aesthetics of maternal care environments, the design of the birth room as well as unit layout and design. These influences, in turn, impact maternal mortality and morbidity, both directly and indirectly.
Aesthetics
The overall aesthetics of the birth experience are important in helping to avoid triggering a fear cascade in the laboring woman, which is known to affect the birth processes by disrupting the normal physiological hormonal response in labor. The aesthetics of the space are extremely important and include all the areas the woman will encounter throughout hospitalization, and should be designed to promote relaxation. Included are the use of warm colors, textured surfaces, a homelike look for furnishings and fabrics as well as the use of soft lighting, natural light, and views of nature. Artwork, posters or symbols using the female archetype, located in strategic places in birth rooms or the unit where the laboring woman might walk, have been shown to be calming and helping to decrease stress.
Birth Room
The birth room contributes to the normal physiological processes of labor. Labor progressing naturally on its own lessens the need for medical interventions. In addition to the birth room aesthetics, birth rooms must have the essential technical equipment such as fetal monitoring capabilities and neonatal care equipment immediately available. However, for some, its’ presence might trigger anxiety or fear, so housing it in concealed cabinetry unless needed is recommended. Similarly, access to emergency supplies in the room is essential to prevent delays in necessary care, but like other technical equipment, should be concealed whenever possible. Another aspect that can trigger the fear cascade is lack of privacy. The spatial filter, which is the interface between the public corridor and the room itself, is a design element to consider. Privacy curtains, half walls, or doors angled in a way that protects the inside of the room from view from the hallway can be utilized to enhance the sense of privacy.
Features of the birth room layout contribute to the normal physical mechanisms of labor. The room’s size, shape and layout configuration should allow for flexibility to change the room for the different phases of labor and to facilitate the woman utilizing the space in a way most comfortable for her. The laboring woman needs to be able to move around and assume varied positions, so having space for optimal equipment such as birthing stools, bean bags, gym mats, wall bars, along with accessible bathrooms with showers and birthing tub is necessary. The amount of time the woman spends lying in bed impacts the progression of labor (less being better), therefore, the ability to easily move the bed out of the way should be factored into the design. Because continuous labor support is linked to successful outcomes of labor, having sufficient space in the labor room for the supporter and their belongings should be prioritized. Lighting and temperature of the rooms should be capable of being controlled by the woman and or her supporter.
Unit Layout/Design
Beyond the spaces that the laboring woman encounters during the birth process, the overall unit layout has important implications for minimizing morbidity. Because obstetric hemorrhage is a leading cause of maternal death and morbidity, managing hemorrhage requires ready access to life-saving equipment, medications and blood products. In particular, birth units should regularly reassess current practices, logistics, and locations of blood products relative to where they might be needed. At “baseline” blood storage be in the same building as the labor unit, but a “better” practice would be storage on the same floor, and “best” practice would be storage of blood product right outside the cesarean section operating room.
Additional insight into the importance of unit layout emerged from the Ariadne Lab and Mass Design Group’s exploratory study linking facility design with cesarean section rates. High cesarean rates having been identified as a key factor in the increasing maternal morbidity and mortality rates. They concluded that more deliveries per labor room, fewer labor rooms per operating room, higher ratio of overflow beds to labor rooms, longer distances between spaces, proximity of on-call rooms, and lower percent of support areas designated as collaborative spaces, were all associated with higher cesarean delivery rates. Limited unit or facility capacity, high workload, and limited accountability for decision–making all contribute to the clinical decision to perform a cesarean section. Normal vaginal delivery is both space and clinical resource-intensive, whereas a cesarean delivery requires only a few hours of clinical attention. When under pressure to make more space for incoming patients, or in times of staffing shortages, a decision point of whether to continue to attempt vaginal delivery or expedite things by performing a cesarean birth is reached. Thus, design elements can play a significant role in that decision.
Conclusion
Despite the limited number of robust studies on the built environment for labor and delivery, the research that exists supports the essential role of the built environment in promoting physiologic labor processes and reducing maternal morbidity and mortality. These initial studies provide some direction for healthcare planners and designers. However, further research is much needed! Looking to the practices and processes from other countries who have succeeded in reducing the alarming mortality and morbidity rates should also be pursued.
Prof. David Allison with Prof. Byron Edwards and the graduate students in Architecture + Health
How has the Clemson Architecture + Health graduate program changed over time?
The Clemson A+H graduate program was formed in 1968 officially with a 10-year grant from the South Carolina Department of Mental Health. The director, George Means, came to academia after working in architectural practice creating buildings associated with the federal Hill-Burton Act. The early years of the program centered around the formation of South Carolina’s community mental health plan after passage of the federal Community Mental Health Act. The studio supported the design of three community mental health facilities which are still in operation today, one of which was published in Architectural Record.
David Allison started as a student of the Clemson A+H program during a time of transition when the studio started taking on smaller community health initiatives. After graduation, David worked in architectural practice in California for several years, then returned to Clemson in 1990 when Professor Means retired. Over the last 30 years, the A+H program has changed from a one-person shop into a more structured curriculum with five full time architecture faculty and researchers plus a nursing adjunct faculty, and a robust research enterprise, the Center for Health Facilities Design and Testing.
What is the value of architectural education with a focus on health?
As Professor Means used to say, “Everything from a doghouse to a hospital is a health care facility. All buildings support or impact health in one way or another.”
A focus on health is a good focus for architectural practice in general. Workplaces, education spaces, health facilities, etc. all share the same concerns. Whether you go back to Vitruvius or feng shui the built environment is designed to support health and well-being. Life and safety are foundational for the architectural profession and licensure. We just do it more explicitly in the Architecture + Health program.
What is the structure of Clemson’s Architecture + Health graduate program?
The structure of the A+H Graduate program includes over forty hours of coursework dedicated specifically to Architecture and Health, including the following classes:
History and Theory of Architecture and Health helps students to understand the relationship between history, health care and architecture. From the holistic health of ancient Greece to middle age miasma theory to industrialization and germ theory, the theoretical foundations of health care environments uniquely influence architecture. Research in recent years focuses more on patient centered care and re-examines the role of nature. Students need to learn from history and adapt to current times.
Health Policy, Planning, and Administration teaches students about the contemporary context of health care and practice. They learn to solve problems related to larger current issues such as evolving demographics, changing technology, reimbursement, policy, a growing body of research, and health-related client expectations.
Architectural Programming and Pre-design is about problem seeking. Students learn a dialogue-based approach with interdisciplinary and collaborative teams to first define then solve problems.
Health Facilities Planning and Design tunnels into critical functional areas and foundations of health care building design. This is a large domain of knowledge at an introductory level since it is always evolving and changing. This class is for understanding core issues, asking good questions, learning where to find knowledge and resources, and educating clients on best practices.
Four A+H specific design studios focus on a variety of health-related problems at different scales (city, street, building, detail) for different populations.
What changes in the profession need to be reflected in the A+H education?
The healthcare architect is no longer accepted as an expert. We must build on our knowledge base, understand its limitations, understand what it tells us, and learn how to translate and apply it. Some people misuse Evidence Based Design (EBD) as only a marketing tool. We work to prepare emerging professionals to use an ever-expanding body of knowledge in collaboration with clients. A+H professionals need to be more than passive recipients of information. They must engage in the intellectual exchange of knowledge.
What skills are essential to cultivate in students?
Students need to seek and apply knowledge to open-ended and complex problems that have no singular answer. There is an increasing need for speed, but the pace of research is slower than pace of design and construction. The industry has made strides in how to deliver the technical part of buildings faster (BIM), but needs to focus on how to integrate research knowledge into the design process in the constraints of time for complex problems that healthcare architecture faces.
A new problem with emerging technology is information overload. Students can find information more easily, but it is hard to select the best knowledge, since both good and bad are available.
What is the vision you have for the Clemson A+H program with regard to integrating research?
Research in architecture in the past has been highly divorced from professional education, physically and culturally, etc. We want to make a deliberate effort to keep the research enterprise and professional enterprise closer together, so research can inform practice more fluidly and practice could influence and direct research, as well as help translate research knowledge for practice.
Time is the limiting factor. Physically co-locating researchers and professional students provides better opportunities for interface.
Where do Clemson A+H students go after graduation?
Clemson A+H graduates enter health care practice at an accelerated level of ability and learning. They typically have greater responsibility and greater opportunities starting out, are compensated accordingly, and recognized in firms. Our graduates tend to rise rapidly in seniority and have an impact in the profession. Not all students go into specialized practice. Some go to smaller firms and do a cross section of work. Most are aggressively recruited and valued at firms of varying sizes that focus on health care.
Clemson A+H has about 260-270 alumni now, one of the largest and most comprehensive in terms of curriculum and course offerings. While the program graduates an average of eight students a year, there is a demand for more than that, but the program at its current size maintains a strong identity and culture.
