Changes in health care and the design field

The Rogers File

CV

• President and CEO of John W. Rogers, Architect, based in Cincinnati.
• President of the American College of Healthcare Architects (ACHA).
• American Society for Health Care Engineering PDC Summit planning committee member.
• Registered architect in Ohio, Kentucky, Indiana and Missouri.
• Past corporate architect for Cincinnati Children’s Hospital Medical Center.
• Past partner and director of health care for GBBN Architects.

Accomplishments

• Founding certificant of the ACHA, Board of Regents member and fellow.
• American Institute of Architects (AIA) fellow, national board member, national treasurer, national convention chair, building committee chair, governance task force member, offshore outsourcing task force chair and AIA Trust chair.
• AIA/Academy of Architecture for Health member.
• AIA Ohio president, Gold Medal recipient and foundation president.
• AIA Cincinnati president.
• Cincinnati Architectural Foundation president.

Education

• Bachelor of Architecture at University of Cincinnati

As he nears the end of his term as president of the American College of Healthcare Architects (ACHA), John W. Rogers, FAIA, FACHA, discusses the many challenges facing the health care design field and how his organization is adapting its programs and offerings to meet the changing needs of its certificants.

What have been your objectives as ACHA president?

Like many offices I have held in my professional career over the years, I look at each leadership role as a verb instead of a noun. My focus this year for the ACHA has been threefold. The first is to explore opportunities to grow our numbers of both candidates and certificants. The next objective has been to create committee alignment with our Board of Regents’ expectations balanced with the needs of the College. In a volunteer organization, it is imperative to use your human as well as financial resources wisely and efficiently. My third goal is to increase the visibility and value of the ACHA to our certificants and the health care field. This year, our certification program for architects was recognized by the American Society for Health Care Engineering as part of their certification programs for health care teams. This was a huge accomplishment and impacted several of our goals.

What are the challenges of recruiting a younger generation to health care design?

The “Silver Tsunami” we are experiencing — the baby boomers retiring at 10,000 people per day — is challenging our growth and stability. We have been able to grow our numbers of new board-certified medical planners while similar numbers are retiring. This creates the ongoing need to grow our numbers from younger generations. As we have studied this issue, understanding communication as well as participation differences become paramount. Discovering the differences and similarities between the generations demands attention to the expectations among the generations and developing responses that meet their needs. This puts a strain on providing services in multiple ways and staying within the financial and human resource limits.

How did you become involved in health care design?

My professional career began with schools, churches, commercial and other building types as well as preservation and restoration projects. Nearly 40 years ago, my mother, who had never been really sick a day in her life, was diagnosed with terminal cancer. I was appalled with the health facilities she occupied or visited and decided to refocus my career path to health care. Health care architecture should clearly address basic human needs while providing spaces that contribute to patients, families and staff well-being. People are never under as much stress as they are in health care facilities. This was an opportunity to enhance my architectural knowledge and expertise, then create environments that improve the patient and family experience. 

What major differences did you see between the commercial buildings you were designing and health facilities?

All facilities have building codes and regulations used for planning and design to protect the occupants from fire and other life safety issues. However, for health care projects, the regulatory compliance takes on a much more significant role. Planning and design are impacted by a multitude of regulatory requirements, many of which may contradict or alter another requirement. The codes and standards change on a regular basis, which requires the understanding of those updates and how to apply them. Because states adopt various versions of codes, a particular state might be utilizing a 10-year-old version of something like a building code or the FGI Guidelines. This makes working and designing in the health care arena much more challenging.

Has the growth of off-campus facilities and ambulatory services changed the way ACHA approaches its certifications?

Our health care delivery system has certainly shifted to a more ambulatory or outpatient care model over the last 20-plus years. That trend continues but also has shifted the demand for care of higher-acuity inpatients. The ACHA, being a credentialing body, must look at the breadth of work done by health care architects. Certainly, a large hospital would be a more complicated project, requiring different code and planning knowledge, than a doctor’s office. We do know that many of our candidates looking to become board certified may work at one end of the spectrum or the other, so we must achieve a balance when reviewing candidates’ portfolios as well as developing questions for the exam itself. Some code and planning issues are similar across the spectrum for planning various types and sizes of health care facilities, but having a working knowledge of the full spectrum is important and critical to the value of certification. We do not certify some candidates for ambulatory facilities and others for large inpatient facilities. The exam questions are reviewed annually for accuracy and relevance and are updated as necessary, based on performance in the most recent exam responses as well as a jobs analysis done every five years to confirm what is expected in the health care field.

Moving forward, what other changes do you see for health care architecture?

Over the last decade or more, data has been collected in large volumes, creating what we know as “big data.” And with the growing development of artificial intelligence (AI), this big data will allow AI to impact health care. AI will be able to provide more accurate diagnosis and care protocols, assuming we are willing to share some critical health information, as our trust in data has been challenged with all the data breaches that have occurred over the years. 

Another shift in care to telemedicine is disrupting many care models, as more monitoring and follow up for certain diagnoses can be accomplished remotely. That will change many care models and require less travel for appointments with providers. This is having a huge impact on health facilities as physicians and nurses are working from telemedicine hubs and not actually working in direct care environments. The college is very much aware of these changes and the impact they will have on the number and type of facilities needed.

How will this change the designer’s role and how can ACHA help them to adapt?

Changing to more information and data-based care is consistent with our societal shift to increasing dependence on technology. The ACHA continues to monitor all these changes and advancements while providing access to education programs that keep our certificants up to speed. Our requirement for continuing education for board certification renewal assures that our certificants will remain leaders of health care project teams across the nation and around the world. The ACHA is pursuing expansion of our board certification for health care architects in other countries to focus on the value our credential provides to owners as well as providers. The bottom line is improving health for everyone.