Staff Efficiency: When designing a new bed floor, we work on making the design as efficient as possible for the nursing staff. We study the footfalls required to do their daily tasks and try to tweak the design until the staff workflow is as efficient as possible. If health systems can minimize their wear and tear on their staff they could have a healthier workforce, less turnover, and higher staff satisfaction.
As a part of my interview series with leaders in healthcare, I had the pleasure to interview Denise Thompson.
Denise Thompson is a Principal with FCA and leads healthcare projects of all sizes. She is passionate about sustainable design and helps lead the discussion about how the firm and its projects can become “greener.” One of the ways she helps realize this goal is by encouraging and mentoring architects and designers to become LEED AP certified. This is also true for ARE candidates in the firm and within the Philadelphia AIA Chapter where she was President in 2016. In her spare time, Denise plays on the office softball team each summer and runs various road races with fellow FCA employees.
Prior to joining FCA, Denise worked in the architecture field on residential, educational, and religious buildings after graduating Cum Laude with a bachelor’s degree in architecture from Temple University. Denise continues to stay connected to her alma mater by serving as a past Associate Adjunct Faculty member as well as being a guest studio critic, lecturer, and mentor. Currently, Denise serves as the Vice Chair for the Center for Architecture and Design where she focuses on their program called “Architecture in Education,” teaching Philadelphia School District K-6 students about design.
Thank you so much for doing this with us! Can you tell us a story about what brought you to this specific career path?
As an architecture student in college, I quickly learned about the positive impact architects can have on people’s lives. While I always believed it, a fellow student did not because she needed her impact to be on a ‘more personal level.’ She left architecture school to pursue physical therapy. I said to myself at that moment, ‘I can touch just as many lives, if not more, by designing the building that those physical therapists need in order to help their patients complete therapy.’
I knew as an architect I would be helping ensure the health, safety, and welfare of the public. It might be a different approach than that of a therapist, but equally as valuable to society. Therefore, when I had the opportunity to work in the healthcare group at FCA, I jumped at the chance to be a part of a team producing such meaningful design work. I feel blessed that I’ve been working in healthcare architecture for the last 17 years.
Can you share the most interesting story that happened to you since you began leading your company?
I’ve been a Principal at FCA for just over a year, so the most interesting thing that has happened has been COVID-19. Helping to lead a firm through unprecedented challenges has required me to adjust my perspective on my role as a leader in the company as well as how I can support my staff and healthcare clients as effectively as possible. We worked to rapidly learn about the pandemic and its impacts on design moving forward so we could advise our clients as to where to make funding. While my first year as a Principal has come and gone, the pandemic carries on, and I will continue to lead my teams and clients remotely and keep learning from the experience, so that we can all move forward together.
Can you share a story about the funniest mistake you made when you were first starting? Can you tell us what lesson you learned from that?
When most architects are just starting out in healthcare, they need to learn all of the healthcare terminology to be able to speak intelligently with clinical clients. It is very common to misunderstand when a clinician uses healthcare-based acronyms or abbreviations, and it takes a lot of research outside of a client meeting to make sure to not mess up on the spot. I know I have made this type of mistake multiple times, and probably still learn something new every day, even after 17 years. I thank all the clients that have generously helped me along the way!
What do you think makes your company stand out? Can you share a story?
FCA stands out because of our people. We have an amazing group of intelligent people that really understand what it means to live up to our mission: challenge the expected, inspire smart design. As designers, we are problem solvers, and our goal is to do just that, as a trusted advisor to our clients. Our staff have the ability to build relationships with ease, empathy, and excellence. I believe that is reflected by the high percentage of repeat clients we have.
What advice would you give to other healthcare leaders to help their team to thrive?
I believe listening to your team is the most important trait a leader can have. We need to be empathetic to challenges our teams face in order to help them overcome any adversity and ultimately get them to thrive within the company. Also, never underestimate the power of a sincere “thank you.” A company will thrive when its team truly feels appreciated.
Ok, thank you for that. Let’s jump to the main focus of our interview. According to this study cited by Newsweek, the US healthcare system is ranked as the worst among high income nations. This seems shocking. Can you share with us 3–5 reasons why you think the US is ranked so poorly?
Given that my expertise is in healthcare architecture and design, I can speak solely from that perspective.
One area where architects can make a huge impact on the American healthcare system is by promoting wellness within hospitals as well as in their homes and businesses. I am particularly passionate about healthy building materials. It seems counterintuitive that the buildings we visit to get healthy can also make us sick due to unsafe building materials. I am thankful that new products are eliminating VOCs, Formaldehyde, and other toxic chemicals from all buildings in this country. I’m optimistic that this will promote better health within the population as a whole, due to reduced environmental exposures in this country. That way, we can catch up to our counterparts in other countries who have been designing healthier, more environmentally friendly buildings for years.
Another area that many health organizations are hoping can improve the quality of healthcare in this country is the use of technology. We are designing more spaces to accommodate telehealth, self-check in, and patient output/patterns that create a more efficient patient experience. The hope is that through design and technology, people will have better access to convenient, yet quality care.
The area that I would like to do more research on is construction, given that the costs are higher in the United States versus the price in other countries — which can heavily hinder the health system’s ability to provide lower costs of care. The referenced study does not take into account construction costs, and I frankly found little else out there on the topic, so I’d like to undertake this research in the near future to discover the reasoning behind it.
You are a “healthcare insider”. If you had the power to make a change, can you share 5 changes that need to be made to improve the overall US healthcare system? Please share a story or example for each.
Through an architecture and design lens, my five recommended changes are all tied to efficiency.
- Energy Efficiency: Operational costs are tied to the total construction costs of the healthcare facilities we design. I believe that if hospitals could become more energy efficient and reliant on alternative energy methods, they could free up operating dollars to give back to the delivery of care. This is difficult due to the complexity of hospitals, as they need to be operational 24/7, require complex HVAC requirements, and have high medical equipment plug loads, all attributing to the highest energy usage of any building type. The industry needs to work together to understand what the opportunities are to think outside the box to solve these complex problems. Similar to the rankings above in healthcare delivery, U.S. hospitals also have the highest climate footprint compared to any other nation. Please see the information I’m referencing in the article linked here: https://www.fiercehealthcare.com. We need to work towards carbon neutrality to have any chance at supporting our world in the future.
- Staff Efficiency: When designing a new bed floor, we work on making the design as efficient as possible for the nursing staff. We study the footfalls required to do their daily tasks and try to tweak the design until the staff workflow is as efficient as possible. If health systems can minimize their wear and tear on their staff they could have a healthier workforce, less turnover, and higher staff satisfaction.
- Patient Efficiency: We not only work with clinicians to make their workflow more efficient but also design the patient experience as efficiently as possible. One example is in a recent emergency department expansion where we tripled the size of their existing space but needed to work with them to develop a new way to tend to low acuity patients to enhance throughput. We designed a results waiting area that would free up exam rooms for those most in need. The clinical team tested it and developed their process during construction so that when the building was complete, they were trained and ready to operate their new workflow. Patient satisfaction scores have risen due to shorter wait and treatment times.
- Technology Efficiency: As previously noted, if health systems can adopt greater technology it can make their systems more efficient and ultimately save them money. We recently designed an outpatient center that converted to electronic sign-in for all patients before or upon arrival. Therefore, the system did not require on-site FTEs for the arrival sequence. The need for waiting space was also reduced as patients were given a room assignment upon electronic check-in and could go directly to the exam room. This square footage could be given back to clinical space, allowing for more exam rooms, and more throughput. Since opening in 2017, this client has been able to see 30% more patients a day due to a more efficient design.
- Design Process Efficiency: Lastly, FCA has worked with many of our clients through a charrette process when designing new buildings that allows the design process to be shortened overall. This requires administrative buy-in to commit the clinical team resources to a more intense, multi-day process. Consequently, at the end of it, all of the key stakeholders have ownership over the process and can come to design decisions faster, allowing the project to come to market faster and generate revenue quicker.
Ok, its very nice to suggest changes, but what concrete steps would have to be done to actually manifest these changes? What can a) individuals, b) corporations, c) communities and d) leaders do to help?
It takes a consistent focus on efficiency from every stakeholder. For individual patients to demand a more efficient yet welcoming and equitable delivery of care, corporations have to look at “leaner” design and technology funding to streamline their workflow. Communities also have to encourage their hospital partners to be more energy efficient for the sake of the surrounding environment. Lastly, leaders must commit to investing in the experiential design for their patients and staff, with workflow efficiency being the main goal. Treating each issue like an architectural project gives a proven framework to come to a solution that can be successfully executed.
I’m interested in the interplay between the general healthcare system and the mental health system. Right now, we have two parallel tracks, mental/behavioral health and general health. What are your thoughts about this status quo? What would you suggest to improve this?
Architecturally, we have been working hard to improve spaces designed to accommodate behavioral health. It has been difficult in the past to design a safe space for our most vulnerable patient populations, while ensuring they aren’t made to feel uneasy or disconnected. I would encourage any healthcare provider looking to design new spaces dedicated to behavioral health to keep this in mind and challenge your design teams to come up with solutions that are both safe and well designed.
How would you define an “excellent healthcare provider”?
From a design perspective, an excellent healthcare provider to me is someone who understands that good design is good business. Certain facilities sometimes want to cut out key design features due to budget constraints and while we understand the financial challenges they face, our goal is to create a beautiful design solution to holistically treat the patient and provide value. Studies have shown for over 40 years that access to views and nature help speed up healing time so providing these types of amenities to patients and staff can have a positive impact on the bottom line.
Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?
My favorite life lesson I learned from my junior high school guidance counselor: “If you don’t know what you don’t know, you’re screwed.” Of course, at the time I didn’t know, but as I grew up, I used that as my mantra to be as self-aware as possible. I always try to learn everything I can, admit when I don’t know something, and have empathy for others in a situation. I share this with all of the staff and young architects I mentor, and think of it when working on a new project type or navigating a new situation.
Are you working on any exciting new projects now? How do you think that will help people?
I am working on a few new and exciting projects! I recently completed a labor and delivery suite and I am also about to start a new one for the same client on another campus. As a mother who delivered two children in a hospital, I felt I had real-world experience that was valuable to the team and to the design. This is usually the one time in a patient’s life that they are happy to be in a hospital and it is a nice opportunity to design higher-end spaces where patients often “shop around” for their service. I think this project will help people the most via the NICU that we designed along with the delivery suite. We worked collaboratively with the head neonatologist to design the space based on research regarding the positive impact of circadian lighting, soothing color schemes, and flexible room types to accommodate the health needs of each patient.
What are your favorite books, podcasts, or resources that inspire you to be a better healthcare leader? Can you explain why you like them?
Most of the podcasts I am listening to are about architecture or leadership in general, but lately I have been reading many articles about racism both in healthcare and in architecture. I am interested in learning about the history of both areas and how I can work toward ways architecture and design can support anti-racism in the healthcare industry. Our firm is working to address this internally and started an Equity, Diversity, and Inclusion committee to provide training and recommendations to our firm on how we can support our BIPOC employees and positively influence our future designs to be more inclusive. We are at the beginning stages of this work and I have a long list of books on my list that I am working my way through. Some of them from the healthcare perspective that I have yet to read are Black and Blue: The Origins and Consequences of Medical Racism; Just treatment: A Cure for Racial Inequality in American Health Care; and The Health Gap: The Challenge of an Unequal World.
You are a person of great influence. If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. 🙂
I truly believe the movement of providing healthy, efficient, and inclusive healthcare through smart design can have the greatest impact on the largest number of people. This is at the macro and micro scale. If all hospitals in this country were designed and retrofitted to be net-zero energy, the impact could be enormous. Health Care Without Harm (noharm.org) is a great resource looking to transform healthcare to promote environmental health and justice and one I look to as the go-to movement I would like to see embraced by all hospitals, healthcare designers, and healthcare influencers around the world.
How can our readers follow you online?
Thank you so much for these insights! This was so inspiring!