Healthcare Planners Take Design to the Next Level

When you think about healthcare, you might think about doctors, nurses, and other medical professionals who work tirelessly to save and improve lives. You also might think about all the equipment involved — MRI and Xray machines, CAT scanners, high-tech hospital beds, heart monitors, etc. But what about how it all fits together and flows in space? For this episode of Side of Design, host Jarett Anderson spoke with some of BWBR’s talented healthcare planners to learn about this incredibly important role.

Hosted by: 
Jarett Anderson - BWBR Project Manager

Guests:
Brian Zabloudil - BWBR Principal and Senior Healthcare Planner
Sophia Skemp - BWBR Project Planner
Scott Holmes - BWBR Principal and Senior Healthcare Planner, retired

Music provided by Artlist.io
Siberian Summer by Sunny Fruit
DuDa by Ian Post

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Transcript

Matthew Gerstner  00:10

This is Side of Design from BWBR, a podcast discussing all aspects of design with knowledge leaders from every part of the industry.

Jarett Anderson  00:19

Hello and welcome to Side of Design from BWBR. I'm Jarett Anderson, your host for today. On this episode we'll be talking with some of BWBR's talented medical planners digging into why this role is so important in creating truly healing spaces. Joining us is Sophia Skemp medical project planner and one of healthcare design magazine's 2022 Rising Stars. We also have Brian Zabloudil, principal and medical planner with 20 years of experience, and Scott Holmes, a newly retired principal and medical planner. So Scott, you're newly retired, thank you for joining us, I think you're on maybe week two or week one of retirement 

Scott Holmes  01:02

Week one!

Jarett Anderson  01:03

We appreciate you sticking around before you hand in that computer to give us some thoughts about medical planning in general. And I'll just toss this out to everyone right now. And whoever wants to step forward first and answer it, that'd be great. But for any those out there that are listening and aren't familiar with what a medical planner does, what's that elevator pitch? Or what's that short, you know, catchy thing that the medical planner does or doesn't do?

Sophia Skemp  01:32

I can propose my elevator pitch. 

Jarett Anderson  01:34

Sure. 

Sophia Skemp  01:35

I would say a medical planner, in a nutshell, is an architect, designer that is knowledgeable of the processes and operations and all the nuances of a healthcare environment. Because healthcare environments are complex. And whenever there's complexity, there's a need to have specialization. And that's when a medical planner walks in the door.

Brian Zabloudil  01:59

I would say it's really about problem solving. Hopefully, at its core, right. We're listening to our clients the challenges they have, we're taking, like Sophia said, operations, and thinking about a future state that may be more optimal to allow them to do more with less, to be more efficient, to better help families, providers, parents, in the case of Pediatrics. That's a passion of mine is women's and children's hospitals that I have worked on for many years. So trying to think about how do we create better environments for all of those individuals?

Scott Holmes  02:35

I think Sophie and Brian hit it on the head. But I'd use a simple phrase. I think medical planners are Jedi Knights. It's already been hit on a little bit, but you know, you need to be a good listener, and you need to be a problem solver. But you have to be good at building consensus and not in the Jedi mind trick way, but you really have to come at it with listening to everybody and getting all those opinions. Medical planners are interpreters too. And healthcare is just full of jargon and acronyms. And not the entire team understands that, so they have to be the interpreter of that. Medical planners are fortune tellers. You're designing not for today, you're designing for the future. You have to anticipate what trends are cheap changes in reimbursement, changes in technology, changes in competition, Brian alluded to a little bit about the change, we got to be an agent of change. I had a nurse friend that often talked about nursing folks are steeped in tradition, you know, they don't like change. And we have to help with that. And I think Brian alluded to problem solver. I think often, we have to, we have to be the one to help them understand what their problem is. It's like, you and I going to the doctor because we got some ailment. And we do the Google search and we think we know what the the issue is and we're almost always wrong. And I think our clients are often wrong. They they know what they have issues in the ED, it's not flowing, right. And they assume it's not enough room. So while that might be part of the issue, it might be they don't have the right care teams. The rooms may be too small. It may be broken processes and lab and radiology that takes a long time and maybe not enough beds. And so part of our job is to understand or interpret and observe and really pull out what are the problems that we're trying to solve? 

Jarett Anderson  04:41

And I imagine Scott, that a lot of that too has to do with a lot of what you're dealing with as a medical planner has to do about when you show up on the scene. How early in that process. Can you show up early enough to influence the budget and figure out what the program is and all of that or has the program itself been defined. And now you need to go back and figure out how the program itself evolved into that. Right? Because I think at what we also do is ask questions right? To to get some of those answers.

Scott Holmes  05:17

Well, I think everybody here, I know Brian and Sophie will agree, if we're not at the table early on, then we usually miss the mark. And because often, if we're not involved, and the scope has already been defined, I can almost guarantee that there's issues. And I know, Sophie's dealing with a challenge right now on our project that had severe scope challenges. And I think that's a often thing. So it works best when we're involved in the beginning, and we help craft a master plan or a vision for them. And then that results in some type of project.

Sophia Skemp  05:57

Less backtracking, more efficient, if we're at the table early, early and often,

Jarett Anderson  06:03

Right. So maybe that starts to get us into, you know, how does medical planning really then add value to the project, and maybe more importantly, positively impact the patients, the staff, the families, and really everyone who can potentially utilize that healing space,

Sophia Skemp  06:23

I know Scott and I were talking about this recently, just going back to adding value and the complexities of healthcare design, but if you consider, Jarett, all of the different specialties that are under that umbrella of health care design, it's such a long list. It's very overwhelming. So as a medical planner, if you're on a team, and you're familiar with, it adds a lot of value to lay that foundation, that skeleton of the project, you know, along with, along with other specialties at BWBR that come at the beginning, you know, our talented project managers setting the budget and the schedule, our our code analysts, adds adds so much value. So it's also about zooming in and zooming out is the best way I can describe it too. So knowing how things need to work operationally with flows and adjacencies. But then being able to zoom in on like room details as well. And having someone on your team that knows that and is familiar with that gets back to bettering a patient experience and ensuring that quality, which is one of you know, you think about the triple aim, that's, that's one of the three main prongs of it is bettering the patient experience and making sure they can navigate the facility as a whole. So we are just ensuring that is possible, as much as possible.

Brian Zabloudil  06:23

Scott had made a comment in there about, sometimes they see or feel a problem differently than an outside perspective may observe, right? Sometimes we're a second and fresh set of eyes, like so they're feeling one thing about, especially like an emergency department, certain amount of pressure, and stress and those peaks. We can function as a fresh perspective on okay, we're listening to you and hear this, we also see this and, you know, maybe we can work in a way to help solve that, that problem in a different manner. Scott also touched on the role of interpreter, which I thought was great. I think in a way, we're almost a liaison between the client and providers, the department leaders, and the rest of the architecture team to be able to be that interpreter and that bridge between heavy clinical operations and heavy architecture, and helping be the one in between on that.

Jarett Anderson  08:44

In the design process itself, you do have that expertise and the patience to facilitate those meaningful conversations, to talk, you know, meet those professionals where they're at, right? We all know doctors and nurses can be really passionate people as well, and I think they're a lot of fun to work with, because they're so passionate. And, you know, you kind of walk with them, I think, in that experience as well. Because the staff matters as well, right, the staff, how are they safe? You know? And do they have respite space and all of that, so that they can deliver their best selves and deliver the best service to the patient as well. Right?

Brian Zabloudil  09:27

To the value aspect of things. You know, there's the qualitative side of things like Sophie was referring to with providing better spaces, healing spaces, spaces that inspire for patients and families and providers. There's the quantitative aspect as well, though, to value ultimately, hospitals are also a business in most cases. And what we do can help impact staffing we can make spaces more efficient. We live in a world now where there are major challenges with trying to properly staff a hospital, whether it's nursing, physicians, environmental services staff. You know, can we create spaces that help hospitals become more efficient from a staffing standpoint.

Scott Holmes  10:13

I find it interesting that sometimes the value that we add doesn't even manifest itself into a project. And I think of one example where, it was a clinic project, and we knew that there were all kinds of opinions about what needed to be done. So we had issued a survey via a Survey Monkey. And so we met with staff to talk about the results and so one of the common comments was they didn't have enough rooms. And we had, we had already done some utilization studies, some observations. And so we're going through these different comments. And, and so I asked the question. So one of the common comments here is that there's not enough rooms. But as we look at these rooms over in this whole hallway, they're utilized less than 15%. And so as we sort of talked about that somebody piped up and said, yeah, the problem is that each physician is assigned three exam rooms. And some of them don't get utilized. And we could share exam rooms. But everybody's got them stocked and set up differently. So somebody in the room says, Well yeah, if we standardized how they're stocked and how they're set up, that issue would go away. So the next common comment was that the rooms are too small. And so again, as we're starting to talk about that, asking, what is it? Are the rooms not wide enough? They're not deep enough is, you know, what's, what's the issue? What came out of that was, it wasn't the size of the room, they they were a little bit on the small side. What came out of it is the rooms were originally designed in the late 90s, prior to computers. And so the desks, the physician desks were never set up for computers, and they were awkward to interface with the patients. And out of that, whatever it was, a 90 minute conversation, what was supposed to be a project ended up, let's tear out the physician desk in a couple of rooms and experiment with furniture solutions. And let's look at how we stock them. And it ended up that we never did do any work in that clinic. It was all furniture solutions. And so I think sometimes that's the value we could add. It gets back to you know, understanding what the problem is the problem wasn't about building a new clinic, it was really looking at how they utilize what they had, better.

Sophia Skemp  12:42

So you just talked us out of a job.

Jarett Anderson  12:43

 Yeah, So Scott, basically utilize data and studies to inform the client and talk them out of a pain, but saving them money, and improving the experience, which is actual value.

Sophia Skemp  13:03

They're gonna, they're gonna remember that. 

Jarett Anderson  13:05

Yeah. 

Sophia Skemp  13:05

Oh, that's, that's the medical planner that saved us a bunch of money. 

Jarett Anderson  13:09

I love it, though. But I think that's that's very us. That's very, we want to do the right thing. 

Sophia Skemp  13:13

Yeah. 

Jarett Anderson  13:14

We want to put that best foot forward. It is about the patient first and serving the client. And you know, our goals as a company, right, about that curiosity, about the honesty, about owning it, I think that story actually represents a lot of that. 

Sophia Skemp  13:30

Yeah.

Jarett Anderson  13:31

You know, Brian, maybe throw this over to you to start, what drew you to this work? And has it lived up to those expectations? And were there any kind of surprises along the way?

Brian Zabloudil  13:42

Yeah, sure. So I, I remember going through college, I attended University of Nebraska, in Lincoln, graduated in 2005. I interned with a firm, all throughout that time. Didn't know I wanted to get into health care at the time. I wanted to be an architect, I knew that. I had a mentor that I worked closely with almost from day one. And he was all healthcare. And I loved, I found out quickly that I loved the programmatic challenge. You know, it's it's incredibly complex. There's a steep learning curve when it comes to the jargon, the the terminology, understanding how to communicate with our clients. And I just loved the idea of taking that really complex typology and trying to create something really beautiful and impactful out of it. That's, that's what I was drawn to early on. And, again, that mentor was in women's and children's design. And I found that incredibly fulfilling. When you finish a project like a children's hospital, and you see the impact that it has. It is so real, and it is very visceral almost, to see that. I specifically remember working on a children's hospital project in Mississippi. It was for a NICU, neonatal intensive care unit. They were going from an environment where there were two large rooms of 48 bassinets babies that are in. Very critical care, very small, very vulnerable patients, and their parents are right there in these two large rooms, you know, piled on top of each other. And we were talking with the family focus group. And this mom said, Honestly, I just needed somewhere to go and cry at times. And I remember thinking, Oh, my God, we can do so much better than that, you know, we have a real opportunity to positively impact people out there with what we do. I just find that so fulfilling. 

Jarett Anderson  15:37

That's a great story. Sophia, I'm gonna I'm going to read a little bit of verbatim stuff from the from the Healthcare Design article that was out there. And maybe maybe ... because it actually pulls in the things that were already been said, here, I make your path to healthcare design was, The quote here is , "what initially drew me to design was the impact an environment can have on a person. Well designed spaces can elicit feelings of calm, clarity and inspiration."

Sophia Skemp  16:08

Wow, she sounds really smart. Yes, yes. Just piggybacking off of what Brian said, you know, that is what initially drew me. And I feel like what continues to draw me into healthcare design. I was drawn to the clientele. I was drawn to patients, and staff, because in my mind, if design and architecture can be healing, who is more deserving than a healing environment than those that are sick, and the people that are caring for them? So that's what drew me in, that's what engaged me, that's what continues to get me to want to contribute more and more and learn more and more about healthcare design.

Jarett Anderson  16:55

Scott, it might be a little bit more reflective for you maybe having an interesting answer being on the other side of retirement now?

Scott Holmes  17:02

You know maybe like Brian, I went to school, had interned at a firm and when I graduated, there just wasn't lots of jobs available. So I went to work for that firm, it was in Iowa, and one of the things they did was healthcare. I'd have to say, as coming out of school, healthcare was probably towards the bottom of the list maybe right before those storage buildings or whatever, you know, not not something that I had ever thought that I wanted to do. And it was probably within that first year, my father in law, was hospitalized, he had bypass surgery. And so I'm going up to this facility to visit him and my wife who had been there for a few days, on a Friday night. And, you know, looking back on it, I'd probably never been inside of a hospital other than, you know, in a emergency room for some stitches or something like that. So I show up at this hospital, and, you know, ask where my father in law, what room, and they gave me the room number and first question on my mouth and was how do I get there? And they said, see that blue line on the floor, follow that to the second bank of elevators and go up the fourth floor. So they had different colored vinyl tape on the floor. And they had waxed over top of it. And that was their wayfinding system. You know, so I show up there, as I'm waiting for the elevator, I hear them paging a code blue, I had no idea what Code Blue was. That was not anything I had been exposed to. I quickly found out as I got up to that floor and headed down the hallway, and I see a patient coming out of a room with a nurse straddling them doing CPR, and just a ton of care teams, only to realize that that was my father in-law. He went into respiratory arrest and was, he ended up in a coma for several weeks. As somebody that was just starting to dabble in healthcare, it was interesting from just embedding yourself. We always talk about you'd be a better designer, if you embed yourself in the workplace or whatever you're designing. And so for me, it was weekends for about eight weeks observing what happened in an ICU. And as I was working on the floor plans on my project, you know, you draw a little rectangle to represent the bed and you think, that rooms big enough. But when you start to throw in several IV pumps, you start to throw in a dialysis machine, a heart pump and all the other equipment, it's not very big. So you start to see that you start to see the commitment of the nurses and how engaged they get into this. This hospital that was probably the example of everything that you shouldn't do. The waiting room for the ICU was inboard, there was no natural light. People slept there, you know, just the furniture wasn't very comfortable. You know, how do you sleep nights on end,? You know, the same door to go in for visitors was was the same door that was used by laundry and trash and everything else. So no separation of flows. And one of the things that never crossed my mind is, in hospitals, people die. So we were there one night when somebody a few rooms down from my father in-law passed away. And you never even think about as a planner, you to talk about all the different movements, you never think about, how do you move bodies, while they paraded it right past the waiting room. You know, just things that we take for granted. I remember trying to find my way to the cafeteria, we needed some food. Down in the bowels of the basement, and you know, it was a struggle to find it. And we picked up some food, we're going to come back up to the waiting room. And one of the things that I didn't notice on the way down, but as I was leaving the cafeteria, right across the hall from the cafeteria, I mean, this was a space that was never intended for public, it was for staff, but right across the hall was the morgue. You know, it's just all these things. And so, I in that couple months timeframe decided that there's a lot that needs to be done in this project type and I could make an impact. And I think that experience really drove me for my entire career.

Jarett Anderson  21:53

That's a deep answer and I can empathize with some of that as well you know, as a project manager and architect. You know, y'all know I have things going on in my family, right. My wife has a four year, glioblastoma, brain cancer survivor. We have a four year old as well, that has PMG, Polymicrogyria, and cerebral palsy, so I find myself in different hospital settings every single week. And that's, it's been that way for the last last five years, essentially. And yeah, those experiences are very real for families, and they're very real for patients, and they're very stressful for the caring staff, right. And me being in those rooms in those situations, and, you know, watching my wife go through it and helping my daughter grow, you know, through PTO, TSLP, you know, all the acronyms, right, you see how much those things really matter. And then you see how much the environment itself helps facilitate some of those things as well. You know, and I remember the first day when Erin, my wife, got diagnosed with brain cancer, and we're sitting there in this really janky looking room. And I don't know what the right term to use, it really is for that, but y'all get it right. And, you know, the architect brain kicked in, I saw, you know, here's a crappy double occupancy room with this, Oh, look at that curtain. Oh, look at this, is this asbestos tile? Let's look at this base. Let's look at the wall. Let's look at all the equipment. And you know, this thing was clearly designed in the 50s. And it's just been equipment, after equipment, after equipment has been putting on these walls, and they're just kind of getting by here. Then you talk to some of the professionals as well, and you, you realize how invested they are in this whole process as well. And then you go to one of their newer spaces, and you're like, that is so different, right? This is such a different environment. Like they're, they had a new ICU versus a really old recovery area. And those two environments were so completely different. I remember as well, you know, before one of my wife's, maybe third brain surgery, we're sitting there at like, 5:30 in the morning, and we're watching the staff walk in for shift change, you know. And like in my mind, like the fox, NFL, like music should be playing like you know like this should be triumphant what these people are doing, right, but it's just another day for them. And it's just another thing and you're just like, wow, what that staff is going through what these patients that are going through and when you're at a cancer center, and you look around and you're like, wait a minute, everyone here is either a caregiver, a staff member or they have cancer going through, you know, their own thing. It's really eye opening. And, you know, I'm glad that we're invested and you all are invested, you know, making in these environments better with natural light, and making them more calm and provide clarity for wayfinding, and providing, you know, healing, inspiration, and all of that. So ..

Sophia Skemp  25:12

Yes. Who is more deserving of good design than your wife? Or your father in-law? 

Jarett Anderson  25:19

Right.

Sophia Skemp  25:19

And you think of those stories, and that's what keeps you motivated.

Jarett Anderson  25:23

So with that said, then what's next are for medical planning? Let's shift gears out of out of the personal stories a little bit and talk about the future of medical planning, and what challenges and opportunities do each of you see? And what what do you get excited about, or the future?

Brian Zabloudil  25:43

I can start it. One thing we've learned, I think, coming out of COVID-19 is to create hospitals, clinical spaces, as flexible as we possibly can to be able to utilize them in different ways. To really think as well about mechanical engineering as it relates to architecture and to be able to segment off different spaces within the hospital. And like how do you cohort patients that are infectious within a patient unit? I think a lot of what we were having to do and help our clients with was reacting to changing dynamics. You know our understanding of the virus and how to better care for patients. How to help our providers, you know, that are fully garbed up there in full PPE, and they're going in and out of spaces. How can we make it so that it's somehow a little less stressful and easier for them? So I think, you know, we don't know what the next thing is, but it will be coming. We will have to react to something else. But how do we make spaces as flexible and adaptable as possible?

Jarett Anderson  26:52

Nice, yeah, that simple thing of just donning and doffing, right? Like really complicates .. 

Brian Zabloudil  26:57

Yeah. 

Jarett Anderson  26:57

... a lot of that. Or how many negative pressure rooms might or might not be needed? And what's the right amount or anti spaces? And that kind of thing? 

Brian Zabloudil  27:05

Yeah, that was the thing too, the the first reaction was, we need to make as many negative pressure spaces as possible. As many negative pressure rooms as possible. When that wasn't the case. What we needed to do was to setup patient units to be able to cohort infectious patients, right? It doesn't matter if you have 12, COVID patients all in one unit, whether they're all negative pressures, again, providers are fully dhondup and PPE.

Sophia Skemp  27:31

I would also say focusing on population health and access to health care. Focusing more on wellness and preventative care, versus just going to the hospital when you're sick. What does that look like, architecturally? Is it just improving telehealth access? Improving the access for vulnerable communities? Yeah, I'm, I'm excited. And I'm curious about what that looks like.

Brian Zabloudil  28:00

I love the health and wellness comment, especially, we do a lot of critical access hospital work, I feel like we are absolutely experts in that and kind of lead the industry. If you think about a critical access hospital through the lens of health and wellness, that it can be a civic center of sorts, right? Often in rural communities, a little more isolated, you know, I think we can look at a critical access hospital as a place where people are drawn to, you know, the local cafe, the dining experience, things like that draws people into as we think about like, physical therapy, right. And sports medicine, those sorts of things that can be a space about fitness, as well as healing.

Scott Holmes  28:48

I think another aspect that is going to continue to change how we design this really the whole notion of research and evidence based design. And when I started my career, you know, it was all about what's the functional things, what's all the equipment, where does it go? You learn by you know, as I mentioned, in observations, you kind of learn from that, and you make some judgments based on that. And I think, as we've seen, really the whole movement of evidence based design and research evolve, it just continues to raise the bar for our designs. And you know, folks like Sophie is involved in some of the post occupancy studies it's gonna just continue to evolve our practice.

Brian Zabloudil  29:34

Scott, you mentioned research, I think research also from the aspect of personalized medicine, right? You're seeing CRISPR, gene editing. Very targeted specific types of treatments for patients as it relates to oncology for cancer care, overall research, being very closely with clinical care. Translational medicine. So that it's more of the bench to bedside type of environment where you're crossing over researchers, and in that group with clinical providers to accelerate breakthroughs. Especially as it relates to academic medicine, right, larger academic hospitals, where traditionally those things were siloed, you know, you had a research tower, you had a critical care tower. And now bringing those two together to be able to accelerate those breakthroughs.

Jarett Anderson  30:24

Something we haven't necessarily touched on is, you know, advice and general advice. And obviously, we're good listeners, we want to be working within a context in a situation. So this question is a little bit zoomed out. But what advice would you give healthcare organizations heading into, you know, a new build or renovation to help them maximize the effectiveness of their efforts?

Sophia Skemp  30:49

Advice that comes to mind is encouraging them to establish their internal group of staff that we meet with as medical planners. Get that group together and hopefully keep it consistent. Things can get very muddy, and inefficient when those people change every other week. Also, establishing guiding principles is very helpful early on in a project. In the whole scope of the project, there are so many questions that are thrown at you as a client and decision fatigue sets in a lot. And it helps to have those guiding principles, or sometimes we call them guideposts too, to refer back to to make sure that every decision that they are coming to is reaching that ultimate goal of the project. One client, and one project that was very successful in this, Jarrett, was Regions hospital, when we did our Family Birth Center. They established their design team very early. They were very clear in their communication of the time commitment that it was going to take. So it was very successful with keeping that a consistent group. They also made sure that everyone was at the table at every single meeting. So they would always tell us a birth center is like a mini hospital within a hospital, because you have inpatient, you have outpatient, you have surgeries. So in order to make sure that the design of the building is cohesive, we need representation from all of those departments. So even though the meeting that we were having, say was only for the labor and delivery floor, we still had representation from postpartum and NICU and triage and surgery. So I know that's a very specific example. But it's it's about establishing the people and the goal is very helpful when heading into a building project.

Jarett Anderson  32:52

Early fundamentals of that, you know, establishing that core team who has the ownership who's emboldened to make those decisions? And then, you know, how's that core team formed? And does it represent a cross section of, you know, the practice? Or, you know, is it just leadership in here? 

Sophia Skemp  33:08

Yeah. 

Jarett Anderson  33:08

You know, that kind of a thing. So they have a lot of those discussions to avoid, kind of take some of the politics and that sort of thing out of it in some ways. And then when you're told you're responsible for something, and that commitment is, is there, I think the discussions are that much more meaningful, as you're going through them, because, you know, they feel the weight of that, as well. And they want to make the right decision and, you know, hear about the evidence, and why are we doing this versus not doing this and that kind of stuff, we're, you know, we need to mock this up, right to make the right decision, that kind of thing, right. So ....

Brian Zabloudil  33:44

You're spot on with having a strong core team set up early on having a clear vision and goals and guiding principles that you can measure options against right to say, hold on, let's take a take a step back, pause. Does this meet our vision and guiding principles for the project, and having that core team that is empowered, ultimately, you'll have large user groups and not everyone's going to agree and you're going to need to put things in the parking lot, take it to that core team, they will need to make a decision and then communicate back to the rest of the team to say here's what we're doing and here's why. That communication is so paramount.

Sophia Skemp  34:22

For the family birth center we printed out the guiding principles kind of like on a little bookmark for all staff to to have and so they would always have them handy to to flip back to and very helpful.

Jarett Anderson  34:36

And then you know, obviously realities of the project are scope, schedule, budget as well. And which is a lot of ...

Sophia Skemp  34:41

Yeah. 

Jarett Anderson  34:41

We take it to the table and yeah, exactly right. Me as the project manager, I have to put that hat on and say that is part of what we do. And I think our medical planners actually think about that as well. Right? Think about the what schedule are we on, what is the right scope, let's ask that question so we don't get in trouble and you know, we don't violate this code or we don't do this over here. We don't you know, when you're replacing doors in your house, then you have to replace the trim, right? That kind of stuff. So what what's the right amount of scope that we have that fits your budget as well.

Scott Holmes  35:14

I think what Brian and Sophie have been talking about, I'm going to use a couple of the buzzwords that are everywhere in our culture today. And that's equity and inclusive process. And inclusive is about getting, you know, all the stakeholders at the table. Equity is making sure that they all have a voice. And so I think historically, you know, looking back, you might have a meeting where a physician, I want this, and nobody else would speak up, even if it seemed like a bad idea. Or they would only speak up after that person left the room. And so I think we're getting better at that I think the other part of inclusivity and equity is making sure that we have patients and families at the table as well in some capacity. And I think we all bring certain experiences that we we know what every patient is thinking and staff seem to think that as well. but sometimes you hear some amazing insights that you don't otherwise hear if you don't have those folks at the table. And I think it's really important to have patients and families at the table. The other advice for organizations is, your decisions need to be based on data as well. You need to extract as much of that as possible. And sometimes that's a challenge with some organizations, they have the data, they just don't know how to mine it from their systems. And we need to look at that because I think sometimes our perceptions, the staffs perception of what is needed is skewed to that one day, last, you know, Fourth of July when all this stuff happened. And that might not be the normal. And in today's world where cost per square foot is just ...  inflation and escalation is crazy,` and reimbursements going down, clients need to make smart decisions about what they're building and how much they're building of each of those components.

Jarett Anderson  37:23

We've reached our last question here for today. And this has been a great, great discussion. We've gone on a while, which is great. So I think this might end up being a longer, longer episode, which is okay. The last thing here is what advice would you give to young designers interested in medical planning?

Brian Zabloudil  37:41

I would say seek out a mentor within your firm. Listen, and ask questions, both internally with your team, with your mentor, with clients. Just ask questions. I would say don't don't pretend to know things. If you don't, I'm not sure I'm going to find out for you on that. That's how we all learn. Those are the main things, listen, ask questions, don't pretend to know everything. It takes a long time to learn things. We're all still learning. I'm still learning Scott is retired, he's still learning.

Jarett Anderson  38:12

That's actually one of my favorite things about design and architecture in general is it is a lifelong learning pursuit because things are constantly changing and evolving. And we need to change with it and try to get ahead of some things for the benefit of our clients and ultimately moving the needle for them as well.

Sophia Skemp  38:31

I would say reach out to people in the industry. Speaking from my experience just here in the Twin Cities that the architecture community is very small. And then the healthcare architecture community is even smaller. So you talk to one person, you're probably going to get several other names of people that you can talk to, and everyone knows everyone. And talking to people is the best insight I feel into medical planning and healthcare design. Because there's just so much to know. You can read about it. You can open healthcare Design Magazine. You can look at all the pretty pictures. But talking to someone is the best way to learn.

Scott Holmes  39:10

So I'm a big Ted Lasso fan and ...

Jarett Anderson  39:13

Believe?  Your gonna say just believe. 

Scott Holmes  39:17

It's another, it's in that first episode or first season. There was a incident or episode there in the bar where they're playing darts. And out of that, Ted, my favorite quote is, "Be curious, not judgmental." And I think so often we you know, we think we know the answer. And we ask a question and we're, the questions skewed because we think that their, whatever they're doing is wrong. And there's a better way. And there may be. But I found in my career just continue to be curious. There are dozens of questions I asked that I wish I hadn't asked because the answers made me a little bit squeamish. But just asking questions and come, you know, even if you disagree with folks in your mind, ask questions and just hear it from their perspective. Be curious, don't be judgmental, and you'll go a long way.

Jarett Anderson  40:14

That's all fantastic advice. And I think it has to do with leadership as well. Because if you are doing those things, you're basically displaying leadership qualities. If you are willing to listen. If you are willing to be curious. You're willing to have the conversations in front of a group, and maybe even be wrong, and learn from that, right? Because those are the things you're going to remember. So I know I've made, you know, plenty of wrong statements in my day and been corrected and have appreciated it just about every time. And you know, I'm going to do it going forward, too. So I think there's an element of humility to it as well, you know, because sometimes you do have to throw something out there to get a reaction with some groups, and you have to take a chance. So taking a chance is also I think part of it as well. And that would be my advice is don't be afraid to take that chance. Let's do it. See what happens. And with that, thank you all so much for your time for your insights, what you do for BWBR and what you do for our clients. Thanks. 

Sophia Skemp  41:20

Thank you. 

Jarett Anderson  41:21

Thanks to our listeners, and we'll see you on the other side.

Matthew Gerstner  41:26

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