Prioritizing humanity in healthcare

Evolving lessons from E. Todd Wheeler in our health practice

The late E. Todd Wheeler

By Sabah Mohammed, E. Todd Wheeler Fellow, Class of 2021

In a resource-rich country like the United States, health care spending in 2020 reached an all-time high of $4.1 trillion, or $12,530 per citizen. That’s twice the GDP (Gross Domestic Product) of India, a populous country with four times the population of the United States. But even so, we rank poorly on every measure of health status.

As baffling as this incongruity is, there is a growing consensus that pathways to better health do not necessarily depend entirely on better healthcare. Health is driven by five domains: genetic predisposition, social circumstances, environmental exposure, behavioral patterns, and quality of health care. The built environment directly or indirectly affects environmental exposure and behavioral patterns. Consequently, the built environment is a critical leverage point to drive healthy outcomes for populations that spend more than 90% of their time indoors, if not more during the peak of the COVID-19 pandemic. The built environment and human behavior continue to be shaped by the aftermath of COVID-19, and there is a renewed focus on designing for human health and well-being. As an E. Todd Wheeler Fellow, this National Public Health Week, I reflect on his legacy and pursuit of answers to some of the most pressing challenges in healthcare design.

Adapted from McGinnis et al. (2002)

The Legacy of E. Todd Wheeler

Wheeler was a Principal at Perkins&Will from 1936 to 1944 and 1957 to 1972. In addition to specializing in the design and construction of hospitals and medical schools, Wheeler looked at health more broadly and investigated how the built environment could shape human health and behavior. Prioritizing humanity in healthcare, finding the balance between technology and humanity, flexibility, and resiliency in the built environment are challenges that ring true even today. Wheeler’s endless quest for answers to healthcare design’s most pressing questions continues to inspire our health practice at Perkins&Will.

E. Todd Wheeler fellow Sabah Mohammed was inspired by the patient-centered design of the Lucile Packard Children's Hospital Stanford during her fellowship

Reviving architecture as a public health intervention

At the 2014 AIA Summit for Design + Health, the then Acting U.S. Surgeon General Boris Lushniak remarked, “Architects are public health workers”. Since then, his philosophy has been echoed by both architects and public health workers, including Dr. Matthew Trowbridge, an advocate for the built environment as a modifiable risk factor for health, and Dr. Andrew Ibrahim, an advocate for Health in All Design. When viewed through this lens, you begin to associate design features with measurable outcomes.

"Architects are public health workers."

–FORMER U.S. SURGEON GENERAL BORIS LUSHNIAK

The concept for the Lucile Packard Children's Hospital Stanford is to recreate the feeling of home for patients and families

Advancing rigor in health care design.

These theories are a guide in this new era. Our commitment to an improved scientific base will yield new insights, both on the determinants of health and on the relative effectiveness of alternative approaches to improving public health. For me, there is a pressing need to develop a more rigorous approach to measuring building performance and associated outcomes. Post-occupancy evaluations serve to measure these long after construction is complete and the building has been occupied. At the building level, this approach must include a rigorous understanding of how social factors and environments affect health and well-being. At the population level, the highest research priority must be to better understand how behavior change interventions can be designed and implemented at varying scales.

In addition to Post-Occupancy Evaluations, my predictions for the future of designing for health include:

Investing in the community as a path to addressing social determinants of health upstream and reducing emergency department utilization and recidivism. Investments in affordable housing and healthy neighborhoods strengthens the communities’ trust in the healthcare system. Cityblock Health has pioneered Neighborhood Health Hubs designed as visible, physical meeting spaces where health and community converge.
A shift to value-based care that moves from a reactive to proactive health care model. Here, health systems will be incentivized to proactively engage with the community they serve. Trust can be bolstered by co-creating with the community through charrettes. The need for trusted agents is particularly pertinent for vulnerable and historically underserved segments of the population.
Improving access to healthcare in underserved communities through mobile clinics that provide individualized and culturally congruent care; mobile vaccination units that aid in community vaccine deployment at scale; and a shift to community-based, whole-person care that moves away from coercive care towards trauma-informed care.
Meeting the patient where they are by overlaying healthcare services onto existing infrastructure through adaptive reuse. This trend is mirrored by the rise in Medtail and efforts by retail leaders like Walmart and CVS to expand convenient care and urgent care services by overlaying them onto existing brick and mortar locations.
Seamless patient experience across care modalities, both physical and digital, to meet the full continuum of care. The healthcare industry has seen significant traction and investment in digital health and the rise in point solutions that risk further fragmenting an already fragmented healthcare experience for patients and providers. This will push stakeholders to consider factors like patient accessibility, outcomes equality, efficacy of technologies, and designing for peer support across modalities.

Amy Sickeler presented her work on the Gardner Neuroscience Institute at the University of Cincinnati

Healthcare Heroes at Perkins&Will

Todd Wheeler’s inspiration continues at Perkins&Will, with energized health care heroes who continue to shape health and healthcare delivery at varying scales. From policy and advocacy to material performance, urban planning to interior design. Robin Guenther has built her career on sustainability in healthcare and material performance. Amy Sickeler champions evidence-based design and designing for neurodiversity. Marvina Williams brings her expertise and operational insights as a clinician along with her personal experience as a cancer survivor to visioning sessions.

The next generation of healthcare design leaders

On the horizon, we have a newer generation of design leaders who are driven by curiosity, compassion, and creativity, bringing their own approach to the practice: Cierra Higgins focuses on the role of community planning in addressing the public health crisis; Kinjal Shah specializes in quality improvement in women’s health and the maternal mortality crisis; Neha Rampuria concentrates on the impact of healthcare IT on our aging population; and I work on quality improvement in behavioral health service lines and the future of the maternal-infant experience. As designers of the built environment, we play a considerable role in shaping the future of health. Today, as I reflect on the legacy of E. Todd Wheeler, I realize that we still have work to do as we move the needle on the future of health.

Learn more about the E. Todd Wheeler Fellowship here.

To learn more about the Healthy Building movement please visit the Human Experience Lab, Material Performance Lab, and the Inhabit Podcast.