Center for Health Facilities Design and Testing

Image by Swati Goel

By Swati Goel

Approximately 187,000 students enroll in a Ph.D. program each year in the United States. My journey is specific to Clemson University’s Planning Design and Built Environment cohort of 2023, with a concentration in Architecture + health during COVID-19 times. I would say that makes it quite unique.

I am an international student from India. I am trained as an architect. My research interest brought me to the United States in 2017 to get a master’s degree in design and health from the University of Michigan. I started my Ph.D. program at Clemson in the fall of 2020 after working as an architect for two years (to ensure I was making the correct decision for my career). I am passionate about architecture and mental health and was looking to combine design and research. That is when I stumbled upon Clemson’s Architecture + Health program.

COVID-19 hit the United States hard a year ago in March of 2020 and slowly took away all sense of community and peer support. Initially, I thought it would allow me to focus better. Still, as time went by, physical distancing began to feel exhausting, and there was no one to share the good and the bad. I had moved to South Carolina from Indiana after quitting my job as an architect and leaving behind all my friends and support system. COVID-19 made it hard to establish new connections at the onset, a crucial ingredient of graduate school.

The first semester at Clemson University was a significant change and called for adjustment. I had moved multiple times before, but this time was different with no previous acquaintances. Besides, shifting my mindset from an Architectural Designer to a full-time researcher was exceptionally challenging. It required a complete rehauling of my approach towards work. While designing, architects constantly improvise a set of drawings or writing guidelines, which can be reused and do not need a systematic process. However, research is very organized and novel. The process is unique and requires constant reading and insight. The first two months went into decorating my new apartment, but once that was done, all I had left was my studies and an endless series of ZOOM calls. Three months into it, I realized there was a term for it- ZOOM fatigue! (Fauville et al., 2021)

All the classes were online, research assistantship work was online, and all my friends and family were online. I could not meet people and make many new friends in Clemson. A few months into the program, my advisor suggested that the research assistants work in the Ph.D. student offices while practicing social distancing. It was nice to leave my house and be around my research team once or twice a week. I was beginning to see the importance of peer support while pursuing a Ph.D. We could talk through ways of doing research activities and brainstorm ideas. It is tempting to stay home and sit in front of the computer and plan and read. However, once I started going to school, I realized the importance of in-person interaction, taking breaks, and investing in myself; instead of just being a Ph.D. student. In a study assessing the effects of the COVID-19 pandemic on college students’ mental health conducted at a large university in Texas, 86% (n=195) of the participants reported decreased social interactions due to physical distancing, while 89% reported difficulty in concentrating (Son et al., 2020).

I grew more and more grateful for the support system I found in the other Ph.D. students who I had the opportunity to meet and work with in person. Earlier I used to think that a Ph.D. is a feat to be accomplished alone, but it is the opposite. The more we alienate ourselves, the harder it gets. It needs to be shared and celebrated, at least the first two years! That’s how we grow as individuals and researchers. It gets better. In the Fall of 2020, the Center for Health and Facilities Design Testing (CHFDT) team organized multiple (physically distant) events such as pumpkin carving on Halloween and hikes in nature to enforce peer connection. Clemson University held socially distant football games at the memorial stadium with reduced seating. And finally, in my winter break, I celebrated Christmas with my fabulous new friends in Clemson and later saw my friends in Indiana. These activities reinforced the importance of combining work and play and the power of community and peer support.

I am in my second (spring) semester right now. The expectations are higher, but I feel more at home with myself. I have a nice routine. I am more organized. I am more in sync with my role as a researcher. I have a great support system within my research community and outside. I reach out to my friends and mentors whenever I need them. I am more productive and yet carve time to be myself.

All research papers end with a conclusion! A year later, and COVID-19 hasn’t left our lives; in fact, it has been a unique experience for everyone. Students and professionals are suffering due to more than usual hours spent at home. Clemson’s dining halls are open this spring, and I think the line between sweatpants and jeans is blurred. Screen time has increased, and exposure to sunlight and physical activities plummeted, leading to a rise in mental health issues. In the research at a Texas University, only 76% (105/136) of students utilized any coping mechanisms to handle the stress due to the outbreak (Son et al., 2020). Out of these 105 students, only 30% of students mentioned using physical exercise to manage stress. Another 21% used streaming and social media as a means of self-management. 44% of the students experienced some depressive thoughts due to loneliness and uncertainty. These outcomes worry me, and I wonder how an architect + researcher would respond to that? I do not have a perfect answer, but I am looking.

Personally, COVID-19 taught me to be grateful for my peers and colleagues. I am thankful for a supportive and encouraging team at the Center for Health and Facilities Design Testing. I am thankful to my advisor for thinking ahead of time and encouraging us to return to our offices while being safe. These experiences made me humble and appreciative of little things that I would not have if I were not forced to spend so much time alone. Maybe there is a lesson for all of us here!

Sources:

1.  https://www.statista.com/statistics/185167/number-of-doctoral-degrees-by-gender-since-1950/
2. https://news.stanford.edu/2021/02/23/four-causes-zoom-fatigue-solutions/
3. https://cookchildrens.org/coronavirus/action/Pages/Safe-Reopening.aspx
4. Son, C., Hegde, S., Smith, A., Wang, X., & Sasangohar, F. (2020). Effects of COVID-19 on College Students’ Mental Health in the United States: Interview Survey Study. Journal of Medical Internet Research, 22(9). https://doi.org/10.2196/21279
5. Fauville, G., Luo, M., Muller Queiroz, A. C., Bailenson, J. N., & Hancock, J. (2021). Nonverbal Mechanisms Predict Zoom Fatigue and Explain Why Women Experience Higher Levels than Men (SSRN Scholarly Paper ID 3820035). Social Science Research Network. https://doi.org/10.2139/ssrn.3820035

Image by Sara Kennedy

by Anjali Joseph

I started my work in healthcare design research more than 16 years ago as a doctoral student at Georgia Tech working with Dr. Craig Zimring on synthesizing the literature on evidence-based healthcare design. This literature review and its follow up study published in 2008 clearly showed that the built environment of healthcare settings mattered in terms of improving patient safety, healthcare quality and patient experience. However, it also highlighted the complexity involved in studying healthcare environments and the difficulty in isolating the impacts of single built environment features from other factors such as patient characteristics, staffing and organizational factors. Over the years, I have come to realize that while it is important to conduct research focused around single built environment variables (e.g. light levels, door width) and healthcare outcomes (e.g. patient falls), it is perhaps even more critical to study and design healthcare physical environments as part of a larger work system. This is particularly true in high-risk patient care environments such as patient rooms, operating rooms and exam rooms that involve complex interactions between individuals, teams, tools and technology and the space where care is provided.

Existing frameworks in the health systems and human factors world recognize the physical environment as one of the components of the healthcare work system that impact healthcare processes and outcomes. These models such as the Swiss Cheese Model and the Systems Engineering Initiative for Patient Safety (SEIPS) framework suggest that the onus for providing safe patient care does not solely rest with the clinicians that interact with the patient. Rather, well-designed work systems are critical for achieving safe patient care. The work system as described by the SEIPS framework and others includes the physical environment, the people (patient, staff, families), the tasks performed, the tools and technology used as well as the organizational policies, that dynamically interact with each other over time to shape care delivery and healthcare outcomes.

While these models recognize the built environment as a system component, the physical environment is usually considered a given, hard to change, even while recognized as a significant barrier to care. Human factors researchers often focus on studying individual and team level interventions such as tools to support communication, or device and interface design to support physical and cognitive ergonomics, improve usability and reduce error. This body of research and practice recognizes the role of the physical environment in supporting healthcare work, but the interactions between the physical environment and other elements such as technology are understudied. For example, for one of our projects at the Center for Health Facilities Design and Testing focusing on integrating computer workstations in preoperative exam rooms, we found that while there were studies and tools around the physical ergonomics of the workstation itself and computer interface design, there was a lack of information about how these workstations should be integrated into the physical space of the exam room to support workflows and communication between clinicians, patients and families. This led us to develop an ergonomic assessment tool that focused on the integration of the workstation within the physical space. Similarly, several studies have identified clutter, crowding and noise as significant environmental challenges in operating rooms. However, we found that information on how the operating room physical environment layout and design supported the work of nurses, surgeons and anesthesia teams in ORs was lacking. This led to a multi-year collaboration as part of an Agency for Healthcare Research and Quality (AHRQ) funded patient safety learning lab on safe OR design resulting in a deep understanding of the OR work system, design of a new OR prototype and Safe OR design tool and implementation of our work in two ambulatory surgery centers.

It is challenging for healthcare architects and researchers to study complex healthcare work systems – they are difficult to access and observe, with a steep learning curve involved in understanding and interpreting what is observed. In this context, simulation-based evaluation of physical mock-ups are extremely helpful in obtaining input on work system performance. These evaluations engage frontline clinicians by asking them to simulate clinical tasks in typical and high-risk patient care scenarios using different equipment and technology. This allows staff to experience proposed designs within the context of their everyday work and identify physical environment features that pose challenges. For example, as part of the design process for a new 400-bed children’s hospital, the team at Children’s Healthcare of Atlanta built out a large warehouse with physical mock-ups for 11 clinical areas and conducted three rounds of simulation-based evaluations with more than 154 clinical staff. These evaluations focused on understanding the performance of the work system, resulted in significant design changes to address the 190 workflow and patient safety challenges identified. This project also highlights the importance of collaborating with clinicians, human factors and simulation experts in healthcare facilities to study and design these complex work systems.

A poorly designed healthcare work environment will create barriers to safe care every single day, while a well-designed and flexible physical environment can support the inherent variability of healthcare work. The healthcare facility design process for new buildings or renovations can be viewed as the design of multiple interconnected work systems at different spatial scales. These work systems will shape healthcare work and patient safety for years to come. It is important that healthcare design teams approach facility design projects from a health systems perspective, actively incorporating feedback from front-line staff using approaches such as simulation-based evaluation of physical or virtual mock-ups that allow the interactions between physical space, people, tasks and technology to be understood. Similarly, it is critical that healthcare organizations commit to incorporating questions and approaches related to the physical environment into all of their patient safety initiatives. The physical environment is a critical tool in the quality improvement and patient safety toolbox that is yet to be utilized to its full potential.

Image by Sara Kennedy

By Lisa Hoskins

What has it really been like in architectural practice, education, and research during the pandemic? The way we work changed overnight in 2020. In this article, we share insights from Architecture + Health students, researchers, practitioners, and colleagues.

Communication with Clients

Previously our workdays involved a variety of formal and informal interactions with our clients, in person as well as via phone, voice message, email, text, or video conference. In-person interaction and on-site visits have been replaced by digital communication. This has changed the nature of communication for everyone sensitive to the need to prevent zoom fatigue and engage clients meaningfully. However, in the absence of in-person interactions, there is still the need to build and maintain relationships. The challenge is to communicate effectively and succinctly while also providing value and building trust with the client. Deborah Wingler, PhD, Health and Research lead at HKS in Dallas, TX says “We need to be really thoughtful about what information we are giving and how we are giving it. Maybe before COVID we would just send a quick email or message. Now it might be better to engage with a personal call or video chat to try to maintain personal connections.” Deborah observed that busy health care clients today often appreciate the shorter and more efficient meetings that can be held virtually in less time than larger in-person sessions.

Communication in the Classroom

As a Gen-Xer who did hand-drafting in design studio for my Bachelor of Architecture degree, one of the biggest changes I noticed with the transition to digital tools in the early 2000’s was that students were less able to share their work and discuss ideas with others. Returning to school 25 years later, my first semester pre-pandemic was very different from the undergrad experience. Students worked on their projects on their computers and their work was not as easy to see, even though the professors tried to impose a “work in studio” rule. The workflow and desk crits now used in design studio for Clemson Architecture + Health students is on a group Zoom using Miro Boards and/or live shared screens to navigate within a digital domain with design software (Sketch Up, Revit, Rhino, etc.). This allows students to see each other’s work and hear the feedback that others receive. The increased use of virtual tools to share work in progress has facilitated some of the peer-to-peer learning that I have been missing. Hopefully, in the future we can maintain this way of collaborating and sharing with digital tools while also building the connections and camaraderie that time spent together in studio engenders.

Dr. Anjali Joseph, a faculty member in the Architecture + Health program has responded to the challenge of promoting student engagement and learning in her virtual seminar course by ‘flipping the classroom.’ In the past, she or other industry experts would deliver a lecture on various topics related to healthcare policy and the built environment during the 2.5-hour class. Now part of the lecture is recorded in advance and students spend most of the time in class actively discussing the topic. Dr. Joseph is also using Miro as a way of capturing student reactions to different issues which helps facilitate discussion. This format makes for a more engaging virtual classroom. She feels she will continue to use this format even after we return to in-person instruction.

Communication for Research

Research in healthcare design often involves facility visits to observe healthcare teams at work or to collect data through interviews, surveys and focus groups. Since the start of the pandemic, on-site data collection has been impossible. However, healthcare design researchers in academia as well as practice have adapted by using virtual reality and online surveys or by training healthcare staff to collect data on their behalf. For example, for our deep dive study on anesthesia workspace design, we decided to use video data (collected for another project prior to the pandemic) to understand the nuances of anesthesia medication administration activities and interactions with equipment and space. Architecture firms are increasingly using virtual reality platforms to ‘mock-up’ spaces so clients can experience different design options from various perspectives and provide feedback. During the pandemic, these virtual mock-up evaluations have replaced simulation-based evaluation of physical mock-ups. Virtual mock-ups are challenging in terms of being able to involve multiple individuals in team-based tasks, and they lack the tactile cues that a physical mock-up provides. However, VR has become a viable short-term solution for envisioning proposed spaces. Perhaps the pandemic will result in greater advancements in virtual reality applications that support user engagement in the design process. Architecture firms are also developing detailed research protocols for data collection that can be reliably implemented by staff at healthcare facilities. For example, staff could be recruited to conduct a post-occupancy evaluation using existing tools. Researchers around the world are working to adapt qualitative and quantitative research methods to pandemic conditions. You can read more about these efforts here – (https://rmsig.aib.world/conducting-research-during-covid-19/)

Communication for Employment

While remote interviews are not new, the way in which communication is changing employment is incomplete without a discussion of the physical work environment. A firm’s office tells us a great deal about its values, efficiency and aesthetic sensibility. The irony of interviewing for a job online is that even though you make every attempt to appear as professional as possible, inevitably a cat walks across the camera, a dog starts barking, or a child enters the room unexpectedly. These informal interactions help us relate to one another on a more personal level, but they alter the formal social norms of the office environment. A classmate noted that trying to interview in person during the pandemic was “weird.” The strangeness of masked and socially distanced interactions creates an awkwardness between strangers that lacks the warmth of a handshake and a smile. In a way, Zoom calls allow this boundary to be crossed, assuming people can sufficiently relax and be themselves on camera, which takes time.

Communication for Fun

At the Center for Health Facilities Design and Testing we are using Slack for group communication and collaboration during the pandemic. It started as an experiment to see if we could replace the ‘conversation by the coffee machine’ with something more digital and informal than email. Having the record of communication in a group forum helps with project management and maintains a strong organizational culture. Personally, I find that the “randomfunstuff” channel in our Slack group provides an outlet for informal engagement. The Slack channel helps us maintain a sense of connectedness, especially since many of us are students who live near campus, but spend most days alone in quarantine. We use the “randomfunstuff” channel to upload pictures of where we live and work, share personal art projects, funny stories, images, and to share birthday and holiday wishes.
During my remote summer work with KMD in California, I enjoyed some firm-initiated photo contests that helped us get to know each other, including best WFH (Work-From-Home) footwear (ranging from funny character slippers to furry heels), and best WFH companion (adorable children, cats, puppies, and even a spider web).

Lessons Learned

Overall, digital tools have facilitated better remote coordination in all scenarios, but they have left many of us with a feeling that something is missing. There is another level of relating to each other that occurs in what sociologist Ray Oldenburg calls the third place. (link: https://www.pps.org/article/roldenburg). It has pushed us to find the maximum potential of remote and work-from-home communication. Perhaps the most important lesson learned is that working from home helps us to better understand how a more diverse physical environment enriches our lives.

Image by Faequa Uniza Rahman

By Sahar Mihandoust

I have seen so many heart-breaking stories recently about healthcare workers across the world stretched to the limits of their capacity – providing patient care in incredibly difficult conditions while concerned for their own safety and that of their loved ones. A recent WHO report titled, “Keep healthcare workers safe to keep patients safe,” found that across the world, COVID-19 infections were far greater among healthcare workers as compared to the general population. Burnout among healthcare workers is a persistent and ongoing problem in the United States and worldwide. When we add the immense stress of caring of highly infectious patients and being asked to manage with limited personal protective equipment, it threatens to stretch healthcare workers and our system to breaking point. According to an AHRQ report, more than 50% of clinicians report burnout, and there is an increasing concern regarding this rising trend.

Factors leading to burnout

Clinicians experience burnout due to the stressful work environments; a recent report from the national academies of science identified excessive workload, administrative burden, workflow, interruptions, and distractions as factors leading to clinician burnout. Burnout in healthcare providers affects both mental and physical health and leads to high turnover; burnout also impacts hospital outcomes and leads to lower patient satisfaction. A recent survey by Medscape suggests that COVID-19 is increasing physician burnout.

Dealing with stress and burnout

Clinicians utilize many methods to deal with work stress and prevent burnout. According to the literature, clinicians primarily use mindfulness and cognitive training to prevent burnout. Other interventions to prevent clinician burnout include spirituality training, mediation, music therapy, resilience training, and yoga. Although found helpful, these methods also require additional time for training and fitting into the clinician’s already busy schedule. The physical environment is an important factor impacting stress and many other factors contributing to burnout. Thus, we must actively consider the role of the physical environment in reducing burnout among healthcare providers.

Supporting clinicians through environmental design

As designers, we can potentially impact clinician’s burnout directly through improving nature views, daylight access, and improved acoustic conditions in the hospital environment. Designers can also improve workspace ergonomics, and the unit design. Further, environmental design can impact clinician burnout indirectly by helping reduce interruptions, distractions, perceived workload, and work-related injuries.

Access to nature

Window views to nature have restorative and healing effects on patients. Clinicians who have higher access to nature views in their workspace, experience better mood, and lower stress levels. Walking in hospital gardens during clinician breaks has also been associated with reduced burnout levels. Indoor plants, artwork representing nature views, and materials suggesting a link to nature are also among elements that decrease stress and improve clinician job satisfaction. Improving visual quality was more highly valued in hospital break areas in comparison to working spaces.

Daylight

Daylight and exterior views also impact clinician outcomes; operating room staff who had access to exterior views and daylight had considerably lower perceived stress. Exposure to windows and daylight has been linked with reduced blood pressure, improved circadian rhythm, and a restorative effect on acute care clinicians. There is also an indirect relationship between daylight access and clinician burnout. According to research, daylight exposure impacts work-related stress and job satisfaction and is found to impact clinician burnout.

Acoustic environment

Excess noise in clinicians working and resting environments can lead to getting distracted, interrupted and can result in added job workload. A noisy environment can also impair concentration and communication and increase clinician stress levels. Design decisions regarding improving acoustical conditions both in the clinician’s work environment and their resting area may improve outcomes for clinicians.

Ergonomics and furniture

Work-related physical discomfort is prevalent among clinicians and especially surgeons; work-related injury and pain are among factors impacting the surgeon’s burnout and turnover. An ergonomic workplace ideally would provide an appropriate setup for clinicians to conduct their tasks comfortably. Another example of furniture design is improving visual and tactile discrimination in the clinicians’ work area by selecting appropriate materials. Selecting proper materials can help clinicians reduce work-related errors. Suitable furniture design can also create a sense of privacy to minimize visual distractions and interruptions. Studies show that back pain and back injuries among clinicians due to movement and transfer of patients is highly prevalent in healthcare settings. Installing ceiling mounted lifts and providing adequate space around patient beds can help in reducing these injuries and improve staff retention.

Physical space layout

The physical layout of the healthcare facility can help reduce clinicians’ stress and burnout. Providing a private escape and a personal space for clinicians close to their working space could help reduce the adverse effects of a stressful work environment’s for both physicians and nurses. Communication and teamwork are among the factors that impact clinician burnout and are also impacted by the design of the physical layout. Hospital unit designs that result in clinicians walking large distances every day could contribute to fatigue and burnout.

Conclusion

While special design changes have been implemented in healthcare settings during the Covid-19 pandemic to minimize the spread of infections from patients to caregivers; there is a critical need to focus on physical environment features that may help reduce stress, fatigue and burnout among clinicians during this stressful time. Access to nature and daylight, improved acoustical conditions, comfortable setup and ergonomic conditions in workspace, and physical layout of space are all among the factors that could potentially ameliorate the effect of added stress and workload and therefore, could prevent clinician burnout.

Rutali Josh and colleagues at the CHFDT RIPCHD project mock up opening (Left to right: Sara Bayramzadeh, Roxana Jafari, Herminia Machry, Michelle Eichinger, Anjali Joseph, Deborah Wingler, Rutali Joshi)

by Rutali Joshi

My journey as a doctoral student began a little over three years ago. Having completed a master’s degree at Clemson University under the guidance of Dr. Anjali Joseph and having seen a few senior Ph.D. students work around me, I thought the two experiences would be similar, but boy was I wrong! Here are some takeaways for those who are embarking on the same journey soon.

The Ph.D. journey is way different than completing a master’s degree.

Generally speaking, no matter what program you are in, doctoral life has two distinct phases: course work (year 1 and 2) and dissertation phase (year 3 onward). Doctoral coursework is similar in structure to a master’s program – juggling between classes, deadlines, homework, tests, group projects, and presentations. The only difference is that doctoral students are held to far more rigorous standards of participation, performance, and critical thinking.

Don’t shy away from expanding your skillset.

Diving into the most advanced methods of research design and analysis during your coursework phase will build your foundations to be a skilled researcher and prepare you for your dissertation phase. Though some tools you learn may not be directly applicable to your dissertation, sign up for courses that interest you or even intimidate you. For instance, I detested advanced quantitative data analysis and statistics. One basic statistics course every semester helped me get over the fear. Clemson offers a wide range of relevant courses in various departments like psychology, public health, and industrial engineering, to name a few, and in collaboration with partner organizations like Prisma Health. Put these resources to good use. Refer to the course catalog or Clemson repository to find courses and their syllabi.

Celebrate small victories and big failures.

The nature of doctoral studies, especially research in healthcare, is such that things will not always go as planned. This does not say anything about you as a student. Discuss your failures with your peers and advisors, learn from your and their failures, and make a plan to quickly move on. Celebrate the smallest and biggest victories- be it finalizing your dissertation focus, your first conference presentation, first publication, or clearing doctoral candidacy exams.

Establish a good rapport with your advisor.

While some advisors prefer to keep the relationship professional, others will be involved in even minor decisions related to your work. Some answer emails right away; others don’t for weeks. Some advisors support you to go to conferences, and some won’t. Some will let you do summer internships, and some will consider internships a distraction. I share a great relationship with my major advisor. These are some things I followed over the years that I believe may have worked.
• Be transparent and vocal about your challenges and what you would like to achieve for yourself
• Be sincere towards the work you are assigned/expected to accomplish
• Make sure you understand your advisor’s expectations
• Present a plan, communicate consistently, and receive feedback

Being a research assistant has been the most incredible learning experience of my doctoral journey.

Working 20 hours per week on various projects other than my dissertation and coursework sure was a challenge, but certainly possible with a lot of planning and preparation. It can be overwhelming at the beginning when you are trying to get accustomed to a new program, new people, and a different work culture. Assistantship work is definitely rewarding and provides tremendous opportunities of honing and applying your skillset to conduct meaningful research, collaborating with other students, professors and industry partners, as well as publishing the research.

You can and should have a life other than Ph.D.

Without a doubt, Ph.D. is demanding and requires a lot of discipline; however, that does not mean you cannot have a social life. I have always tried to take a Friday evening (sometimes even the weekend) off to rejuvenate. As time permitted, I have gone hiking, gone to dinner with my friends or colleagues, watched a movie, played board games with friends, and painted. Spend time on what you enjoy doing the most. While trying to wrap up coursework or during the dissertation writing phase, you may find yourself chained to the desk writing for hours, attending meetings, or working on presentations. Even in the most stressful days/weeks/months, dedicating some time for yourself is important. In addition, physical exercise and healthy food should be an integral part of your lifestyle.

Help each other and help yourself.

For some, the dissertation phase can be a lonely journey. I would say it is only if you chose it to be so. Though it is about your research project and your approach, there is always someone to talk to. I may have felt lost at times, but I was never alone. At the Clemson A+H program, we have a very supportive environment for students. Without guidance from the peers who shared the same office with me, my initial years would have been difficult. It is important to know that everybody has gone through the same struggles as you- find that person you are comfortable talking to!

Become that mentor for other first-year students.

Share what you learn from your seniors and your experiences with the first year Ph.D. students to make the process easier for them. Share thoughts about various aspects like selecting appropriate courses, managing coursework and assistantship to meeting advisor expectations.

Last but very important – don’t fall into the comparison game.

It is entirely normal to compare yourself to your peers or even best researchers in the field. It took me a while, but I learned that every researcher has their own learning graph. Ph.D. is a journey of personal growth – do not let yourself get bogged down by what others are doing. Get motivated by the success of others and work hard to achieve your best. Take the time to think deeply about your future goals as a professional based on three things – what I love to do, what I am best at, and how can I contribute the most to my field.

By Lisa Hoskins

Image created by Faequa Uniza Rahman.

Aging in Place

Many of us have been concerned for the health and safety of our elderly parents and relatives during the COVID-19 pandemic, and we worry how our family members can safely get the help they need. In addition to the stresses of a pandemic, aging-in-place is complicated by other factors, including the loss of one’s friends and family in older age groups, cognitive aging, physical frailty and the compounding effects of stress or chronic health conditions. In our working lives, we have become increasingly reliant on technology to keep us socially connected and productive and many of us have started utilizing technology to support our everyday lives. New advancements in technology in the built environment can facilitate living at home alone in our senior years.

Basic Technology Needs

A complete technological home system at the most basic level requires electricity and internet connectivity. Increasingly, internet connectivity with adequate communication speed can be achieved not just through wired broadband connections, but also through wireless hot spots available from cellular phone providers. The pandemic has brought recent attention to the issue of broadband access. Increasing access benefits people of all ages. Once basic operation and connectivity is established, safety and health technology features in the home increase exponentially.

Technology Barriers and Facilitators

Barriers for aging might initially involve difficulty with Instrumental Activities of Daily Living such as driving, meal preparation, house cleaning and managing medications. Smart cars, online shopping and telehealth are increasingly helping to ease some of these burdens. The pace of adoption of technology by older adults is rapidly increasing. AARP reports that in the past two years, smartphone adoption has increased to 77% of older adults. Helping seniors learn to effectively use technology is a key facilitator. In my own family, the desire to connect with distant friends and family members through video chats, exchanging photos and social media has been a motivating factor.  However, security settings to protect private information must be user-friendly as we all become more conscious of how data may be shared through technology.

According to the CDC, one in four older adults falls each year. Emerging technology can help seniors to evaluate the safety of their homes. In a recent study conducted by researchers at the Center for Health Facilities Design and Testing, a majority of the older adults interviewed indicated that they would be interested in a home evaluation app that would allow them to evaluate their homes to identify any changes that they could make to support aging in place. The information garnered via the app could then be used to communicate with health providers who could provide specific recommendations to prevent falls and facilitate mobility. Voice activation, large interface buttons, and simple-to-use programs help make these kinds of apps more accessible to older adults.

Technology for Home

Sensors and appliance alerts can already let us know if we accidentally left the refrigerator door open or left the oven on for too long. Automated locks, doorbell cameras, lights and thermostats allow us to answer the door, turn on the lights and adjust the temperature through pre-set scenes and schedules or verbal commands which require no physical manipulation or ambulation. For users who do not prefer wearable technologies such as pendants or smart watches, emerging smart home technologies will soon utilize motion detectors, pressure sensors, and cameras in the built environment to track levels of activity, location, and movement. While privacy may be a concern, artificial intelligence holds the promise of activity detection and characterization for regular reporting and alerts to caregivers without sharing private video feeds

Activity Support

While smart home technologies increasingly facilitate instrumental activities of daily living, supporting basic activities of daily living is the next frontier. This includes walking, bathing, dressing/grooming, toileting, transferring, and eating.

Assistive technologies such as smart chairs and beds can help us to sit, stand, or recline. Bathrooms can be augmented with grab bars and shower faucets that we can hold by hand and activate with a button to pre-set water temperatures. Retrofit bidet toilet seats now help with personal hygiene as well as self-cleaning. Robot vacuums and automatic cleaner-sprayers can help with house cleaning. The world of fiction ignites our imaginations with robot companions and assistants, but these technologies require much more development for functionality, ease of use, and affordability. Integrating smart technology into the home is one of the best ways to facilitate aging in place today.

Additional reading:

“How Covid-19 Will Change Aging and Retirement”, Wall Street Journal

Mobile Technology for Adaptive Aging:  A Workshop, The National Academies of Sciences, Engineering, Medicine 

Deborah Wingler being congratulated by President Jim Clements at her doctoral hooding ceremony

by Anjali Joseph

If I were to turn back time to exactly 20 years ago, I see my younger self trying to make sense of what she wanted to do with her life. In November 2000, I was in my third semester of graduate school at Kansas State University and I had realized that I loved environment and behavior research. Nothing excited me more than studying how Architecture impacted people’s behavior, their interactions with each other and their environment. My master’s work had whetted my appetite for built environment research and I began to explore PhD programs. Thankfully, I had some great mentors at KSU and they pointed me in the direction of schools that might be a good fit with my interests. I was extremely fortunate to end up in the right school with an excellent advisor (Georgia Tech with Dr. Craig Zimring). However, I don’t think I really knew what I was getting into and where this Ph.D. would lead. I don’t think I necessarily asked the right questions when I talked to my potential advisors. I was probably in awe of these incredible educators and just grateful that they would be willing to talk to me!

Twenty years later, I am on the other side. At this point, I have worked with several doctoral students and post-doctoral faculty and I frequently interview prospective students interested in studying at Clemson. Here are some words of advice I would have had for my younger self that I share here:

1. Thoroughly research the work of your future advisor:

Research the work of your future advisor by checking out their website and reading about their interests and ongoing projects. You should find their work interesting and ideally, there should be a good fit between your interests and passion and theirs. Sometimes, you may end up carving out your individual research from within a larger research program they are leading. Your advisor will be most motivated and interested in supporting you through the long Ph.D. journey if there is a strong fit between your interests and theirs.

2.  Make sure your advisor has an active ongoing research program that you will be able to participate in:

As a Ph.D. student, you will likely be hired as a research or teaching assistant. A research assistant primarily works on research projects, assisting the faculty member and other team members on research related tasks. As a teaching assistant, you may assist your advisor or other faculty with teaching in lecture classes or design studio at the graduate or undergraduate level. A PhD student will benefit from obtaining both teaching and research experience. If your goal is to go into academia with a primary focus on teaching, teaching assistantships, especially studio teaching experience, can be invaluable. However, if you aim to build a strong research program of your own (in academia or practice), I would strongly recommend obtaining experiences as a researcher. As a member of an active research team, you will learn a range of skills from conducting literature reviews, to collecting and analyzing data and writing manuscripts that will help you grow in confidence as a researcher. Further, you will learn to work with faculty and other students in a team environment that will help you as you build and lead your own team. Being listed as a first author or co-author on journal articles will certainly help when you start applying for jobs.

3. Consider the connection between research and practice in your school:

Research in built environment and health is often conducted with the goal of understanding how design can help improve health and well-being of occupants. Research in this field is most impactful when we work with architects and other stakeholders to address critical problems in practice. Research programs that are well integrated with undergraduate and graduate programs in Architecture or other design-related fields facilitate a more direct connection between doctoral research and its application in the real world.

4. Talk to other doctoral students in the program you are applying to:

Make the effort to reach out to other doctoral students in the program you are applying to or better still ask your potential advisor to connect you with other students. Ask these current students about their research and their relationship with their advisor. Find out about the types of projects they work on as part of their assistantship. Talking to current students and recent graduates will also give you sense of how involved they are with the industry and what their priorities are, which could give you an invaluable perspective regarding your own future prospects. Current students could also provide valuable insights about working and living conditions in the city you are planning to move to. I was planning to move to Atlanta with my 1-year old and husband, and family housing and daycare were huge concerns for me.

5. Understand where your Ph.D. might lead you:

Talk to your potential advisor as well as your current mentors about the different directions and career options available to you after a Ph.D. in Architecture. Traditionally, a Ph.D. in Architecture led to a career in academia. However, increasingly researchers are being hired by Architecture firms to conduct design research to support integration of research and evidence into design practice. Here is a profile of a Clemson PDBE graduate who leads the HKS healthcare research portfolio.

6. Visit the school and spend time with your future advisor and colleagues:

If at all possible, you should try and visit the school and city where you will likely spend the next 4-5 years of your life. Spend some time observing the interactions between your advisor and other students and faculty. Sit in on a class if you can. Talk to other faculty and students. Try and visit the places where you could potentially live.

7. Make sure you are ready for the hard work and commitment that a PhD involves:

A Ph.D. is a long-term commitment (3-5 years) that requires immense discipline, hard work and perseverance. You have to have an abiding interest in your area of research to sustain your enthusiasm through all the ups and downs. Doctoral work involves a LOT of reading and writing and is a significant departure from the more graphical and visual methods of analysis and communication used extensively in Architecture education. The transition to the extensive reading and writing required in your Ph.D. program can be difficult in the beginning.

This is my perspective based on my experience as a doctoral student and now as a faculty member who works with Ph.D. students. Others who have followed a path similar to mine or a slightly different one may have other advice to offer. Even if you think you know what you want to do in your Ph.D., be open to new experiences and challenges and see where they lead you. The right program will give you many tools to succeed, but in the end, it is up to you to make the most of your journey as a Ph.D. student.

Interview Highlights with David Allison, Director of Graduate Studies in Architecture + Health and Alumni Distinguished Professor of Architecture

By Anjali Joseph and Lisa Hoskins

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.

Click here for more detailed curriculum information at Clemson Architecture + Health.

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.

For more information on the Clemson Architecture + Health Graduate Program, click here.