Building on a legacy of health care design

A. Ray Pentecost III brings a lifelong career of health care design knowledge and experience to his new post as director of the Center for Health Systems & Design at Texas A&M University’s College of Architecture. In this month's HFM Interview, he talks about the challenges ahead.   

What is the Center for Health Systems & Design’s mission?   

The Center for Health Systems & Design (CHSD) was launched in the Texas A&M University (TAMU) College of Medicine as the Center for Health Systems and Technology (CHST). In the mid-'90s, the priority of design in the work of the CHST led university officials to change its name and move it to the College of Architecture. Historically, its mission has been to promote research, innovation and communication in an interdisciplinary program primarily focused on health facility planning and design.

What areas of health care design will the center emphasize going forward?  

Without question, evidence-based design will continue to be a top priority for the CHSD. Properly introduced into practice, I know of no other design influence that fuels creativity to a greater degree. 

Additionally, the CHSD will clarify and strengthen its vision by fully exploiting three dimensions of designing for health: design that protects health; design that develops or enhances health; and design that restores health. The center is investing heavily in faculty, Fellows and other resources to further enhance already exceptional opportunities and agendas.

The Pentecost File

CV

• Board-certified health care architect
• Director, Center for Health Systems & Design, College of Architecture, Texas A&M University, College Station
• Professor, School of Public Health, Texas A&M University
• President, American College of Healthcare Architects (ACHA), Overland Park, Kan.
• Chair, Board of Direction, Building Research Information Knowledgebase web portal by the American Institute of Architects (AIA) and National Institute of Building Sciences, both in Washington, D.C.
• Former licensed nursing facility administrator

ACCOMPLISHMENTS

• Named to the AIA College of Fellows as well as the ACHA Council of Fellows
• Ronald L. Skaggs and Joseph G. Sprague Chair of Health Facilities Design, Texas A&M University
• Past president of International Academy for Design & Health and past president of the AIA Academy of Architecture for Health
• Chair of Independent Review Panel on Military Medical Construction Standards

EDUCATION

• Doctor and Master of public health, School of Public Health, University of Texas at Houston
• Bachelor of architecture, School of Architecture, Rice University at Houston
• Bachelor of arts, School of Architecture, Rice University at Houston

What do you consider to be the center’s major contributions to health design?   

Perhaps the strongest influence of the CHSD is using research to shape design processes and decisions. That message has been, and continues to be, the heartbeat of the faculty and graduate researchers involved in the program.

A close second would be that the best design comes from the successful integration of many disciplines to solve design challenges. A significant recruiting effort is underway to bring additional Fellows into the CHSD to enrich their own collaborative research efforts in designing for health and to improve their availability to support student research.

How does your background of teaching public health and architecture prepare you as the new director of the center? 

It is a perfect fit for my background in public health, architecture and health administration. Public health trained me generally in population health, but also in health planning. Paired with architecture, I worked in two areas — the development of health care facilities and the development of healthy environments. 

My license in nursing home administration enabled me to enter the world of health care management, including physician management. My leadership at the CHSD is the natural extension of the professional perspectives I have from the integration of these three viewpoints. 

The Secretary of Defense once appointed you to chair an independent review panel to study and develop construction standards for military health care facilities. Can that knowledge be applied to civilian hospitals and, if so, how? 

My first takeaway from working with the Defense Health Agency is that the individuals working in this area are among the brightest and most conscientious I have ever encountered. Their commitment to excellence is intense. 

Three strong parallels between the military experience and civilian hospitals seemed clear. First, the commitment to using the best evidence to drive health care design in the military has been strong and is growing, but the assessment of the impact of that evidence on outcomes and operational metrics is only beginning to gain momentum. Civilian hospitals face a similar imperative. 

Second, the historically somewhat narrow focus on having the best medical facilities and services for our wounded veterans is giving way to a broader agenda that includes improved health and wellness. But the logistics of widening the operational aperture to include both priorities is difficult. Civilian hospitals are also trying to understand their dual role in population health and medicine.

Third, the standards for world-class medical facilities, developed in 2009 by a team on which I served and codified into law in 2010, had six domains, only one of which was the infrastructure or facility. The others were leadership and culture, processes of care, performance, knowledge management, and community and social responsibility. For world-class excellence, all six must work together in the same way for military and civilian facilities alike.

Who are among the luminaries in the health design field who have worked at the center or contributed work to it? 

Where to begin? Former directors have included Roger Ulrich, Ph.D., perhaps best known for his work on the benefits of patients having a view from the hospital window and his advocacy of single-patient rooms; D. Kirk Hamilton, co-founder of the American College of Healthcare Architects and co-editor of the Health Environments Research Design (HERD) Journal; and Mardelle Shepley, one of the foremost authorities on post-occupancy evaluation research. 

Other distinguished faculty have included Susan Rodiek, expert on design research for aging; Chanam Lee, Xuemei Zhu and Zhipeng Lu, all exceptional researchers in walkable communities; and Sarel Levy, known for his work to establish multipliers for health facility area calculations. 

Some of the others include Jim Varni, developer of the Varni scale for pain; Zofia Rybkowski, authority in Lean construction and target value design in health care; and, of course, the iconic George Mann, who this year celebrated 50 years of teaching health care design at TAMU. 

Finally, rigorous research by Sherry Bame early in the life of the CHSD laid a solid foundation for the long-term viability of the program.

Can you describe some recent work by Texas A&M graduate students in health care planning and design? 

Our graduate students have designed a variety of projects, in many cases for real clients, which extend from Texas across America and around the world.

Projects range across the life experience, from urban and rural facilities for children to hospitals, long-term care residences, healing gardens and hospices. Student projects have addressed home health, walkable communities, neonatal intensive care, hearing disabilities, traumatized children and adolescents, autism and rehabilitation of those who are Wounded Warriors. 

My current studio involves designing a microhospital with innovations involving a telemedicine component and community wellness and health promotion features.