ACHA evolves with the health care design profession

For close to two decades, the American College of Healthcare Architects (ACHA) has sought to transform health care through better built environments. Under the tagline "Experienced, Certified, Preferred," the college has worked to use these traits to benefit health care executives, the industry and, most importantly, patients.

It provides board certification to architects in the U.S. and Canada who specialize in health care. The certification process is rigorous and overseen by an independent testing agency to establish a professionally sound, legally defensible standard by which people can identify themselves as health care architects. As of last summer, more than 450 architects have earned ACHA certification, with 50 candidates on the path toward certification.

An overview of the organization's structure, requirements, successful past and challenges ahead shows the growth of health care architecture as a recognized and distinct practice.

Demonstrated knowledge

ACHA-certified architects have demonstrated a deep knowledge of design and its impact on the health care community. According to a survey of its certificants in 2014, the college found:

• ACHA-certified architects have an average of 28.7 years of health care design experience.
• ACHA-certified architects have published an article or a book on a health care topic an average of 4.5 times.
• ACHA-certified architects have presented a topic at a health care conference or similar event an average of 8.7 times.

In addition to the certification program, ACHA offers continuing education and mentoring opportunities to help certificants stay current in their knowledge and assist newcomers in attaining certification. The ACHA partners with the American Institute of Architects Academy of Architecture for Health (AIA AAH) to host their annual Summer Leadership Summit. This event, which is attended by leaders in the health care architecture industry, provides master-level educational presentations and thought-provoking discussions.

ACHA maintains partnerships with other related professional organizations, such as the Facilities Guidelines Institute, the American Society for Healthcare Engineering and the American College of Healthcare Executives. Industry partners like McCarthy Building Cos. Inc., Affiliated Engineers Inc. and Stryker Corp. support the college’s efforts. ACHA also participates in major health care design events.

To keep certificants informed about developments in the field, ACHA publishes a quarterly newsletter and distributes the monthly E-Voice, an electronic news clipping service for disseminating important news articles that concern health care design. Certificate holders have access to an online resource library and white papers published by ACHA. The college maintains a speakers’ bureau of certified health care architects, as well as an online directory of certificate holders that can be accessed by those seeking an ACHA-certified architect in their respective state or jurisdiction.

To further advance the profession, ACHA has several recognition programs for outstanding individuals and notable health care projects. ACHA-certified architects who have completed 10 cumulative years as licensed architects and who have produced distinguished bodies of work are eligible to be nominated to the ACHA Council of Fellows. Each year since 2003, the organization has presented a highly influential architect with the ACHA Lifetime Achievement Award. Groundbreaking projects that have demonstrated at least 15 years of enduring significance are celebrated through the ACHA’s Legacy Project Award.

Long time coming

The ACHA was established as a legal organization in 1999, but the idea for a health care architecture specialization dates to 1963 when the American Hospital Association attempted to create a nationwide list of experienced health care design consultants.

A lack of consistent and enforceable standards led to this project's being abandoned by the mid-1960s, but the concept of a designated specialization in health care architecture never went away. In the 1990s, a core group of about 50 of the most prominent health care architects in North America developed a framework and justification for a health care specialization when they formed the ACHA.

The framework was taken before the AIA for validation. While specialty certification initially created some controversy within the AIA, the idea was ultimately supported and the AIA went on to establish criteria that must be met for a building typology or knowledge community to be acknowledged as an architectural subspecialty. Health care is the first and only building typology to be recognized as such by the AIA — no other building type has created a specialty certification approved by the AIA. The ACHA certification program is re-evaluated and reapproved by the AIA every three years.

The success of this program may be because specialization is common in health care itself, and health care practitioners understand and value board certification. According to Sharon E. Woodworth, AIA, ACHA, health care practice leader in the San Francisco office of Perkins+Will, “My clients are board-certified MDs, so they appreciate my board certification in architecture.”

The founding group of leading health care architects, who had an average of 26 years of experience in the field, developed the material used to create the ACHA’s original certification exam. A professional, independent psychometric testing firm wrote the exam questions, based on the material generated by this group of subject matter experts.

Answering challenges

While ACHA is now entering its 17th year, it has not been without its challenges. Many architects took a hard hit with the recession in 2008. While certification may have been a differentiator in getting new projects, some architects had to suspend certification efforts during that time.

Additionally, the college has seen fewer emerging professionals seeking registration as architects, which is a primary requirement for becoming ACHA-certified. That trend could be changing. Frank Zilm, D. Arch., FAIA, FACHA, director of the Institute of Health & Wellness Design at the University of Kansas School of Architecture, Design & Planning's health and wellness program, reports that in a recent online survey by the Institute, nearly half of the responding 173 young professionals in health care design firms identified achieving licensure as a goal.

In addition, 20 percent of respondents listed certification through the college as a top goal, in the hope of achieving leadership roles within their firms. ACHA founding member Greg Hughes, AIA, ACHA, managing principal with Broaddus Planning, Austin, Texas, says, “Certification has helped me focus on health care exclusively and has positioned me for leadership roles on projects as well as on professional organization committees and boards.”

To preserve the integrity of the testing process, it continues to be overseen by an independent, third-party testing company. Questions are developed by the ACHA exam committee, chaired by an ACHA-certified architect and appointed by the college’s board of regents. These questions are properly framed and reviewed for clarity with input from the testing firm.

This process ensures that questions cover the needed material, are not ambiguously worded and conform to scientifically appropriate models for examining candidates. Because test-takers must be licensed architects, the exam is geared toward topics related specifically to health care projects as opposed to architectural domains already covered by architectural licensure organizations.

The exam is divided into four major sections. These cover the forces that drive the business of health care, such as economics, regulation and reimbursement, health care models and technology; pre-design, including programming and master planning; design; and delivery and implementation. Each item on the test is linked to a specific health care setting, including general, acute care, post-acute care, outpatient care or behavioral and mental health care.

The entire certification process is designed to recognize the expertise of architects who have substantial experience in all aspects of health care architecture projects. Architects who earn the ACHA credential have had their health care experience and knowledge independently evaluated and approved through an application, portfolio and testing process [see sidebar, Page xx]. ACHA certification is a stamp of approval that differentiates architects with specialized health care skills for their clients, employers and colleagues.

While there are many highly qualified and experienced health care architects in the industry, some industry leaders have expressed a preference for working with an ACHA architect who has been through the rigorous certification process. Perry Harrell, AIA, ACHA, principal, Harrell Architects LP, Houston, says, “The ACHA certification gives my clients … added confidence in our health care design abilities. This extra trust has helped us to develop and retain clients.” ACHA encourages all architects with the health care specialty, whether emerging professionals or icons in the field, to apply themselves to the certification process.

Looking ahead

While certification remains its primary concern, the ACHA continues to support programs and initiatives to advance the field of health care architecture.

Future plans include exploring ways to achieve greater alliance with ACHA's counterparts, such as AIA AAH and the Academy of Architecture for Health Foundation. The professionals involved in these groups are friends and frequent collaborators, so preliminary conversations regarding further professional alignment are natural.

There are opportunities for alignment of activities and interests that would serve the industry as a whole to greater effect. Improved partnerships also would reduce duplicated hours and redundant attempts to solicit sponsorships that are necessary to fund important research, education and recognition programs.

This is an exciting time for health care architects and the health care field as a whole.

D. Kirk Hamilton, FAIA, FACHA, is professor of architecture at Texas A&M University, College Station and can be reached at khamilton@tamu.edu; Donald C. McKahan, AIA, FACHA, is principal at McKahan Planning Group, San Diego and can be reached at donmckahan@mckahan.com; A. Ray Pentecost II; , FAIA, FACHA, LEED AP, is professor of practice at Texas A&M University’s College of Architecture, College Station and can be reached at rpentecost@tamu.edu. They were assisted by Dana VanMeerhaeghe, ACHA’s executive director.