Breaking down the walls in health care design

The Mazzi File

CV

• Principal, architect, researcher and senior medical planner at GBBN Architects, Cincinnati
• Associate principal and medical planner at Westlake Reed Leskosky, Cleveland.

Accomplishments

• President of American College of Healthcare Architects.
• American College of Healthcare Architects Fellowship.
• American Institute of Architects Fellowship
• Peer-reviewed white paper published in HERD Journal.

Education

• Bachelor of architecture degree from Carnegie Mellon University, Pittsburgh.
• Master of architecture degree from University of (Tucson) Arizona.

Angela Mazzi, FAIA, FACHA, EDAC, has been bringing a keen awareness of spatial design and its impact on well-being to health care since 2004. Now, she’s helping to lead the American College of Healthcare Architects (ACHA) during her term as president. This month, she talks with HFM about her plans to further the organization.

What were the factors that led you to focus on health care design?

As a child, I was highly sensitive to the fact that space felt like something. I would notice how a room could be experienced very differently from different vantage points, like on top of the refrigerator. As a major in architecture, one of the things I loved most was studying the psychology of habitation and architecture history. The fact that we architects create environments that affect people inhabiting them physically, mentally, emotionally and spiritually fascinates me. While I didn’t start my career designing health care spaces, once I had the opportunity to work on health care projects, I realized that all the things I advocated for mattered 10 times more in these settings. The level of stress and lack of control afforded to patients, families and staff coupled with the long hours that can be spent means it is imperative to create supportive and restorative environments.

How did you learn about ACHA, and what has your involvement included? 

When I started working exclusively in health care, I noticed others in my firm had the letters ACHA after their names. I decided that if I was going to design health care environments, I should become certified. Having this credential communicates that I have a peer-reviewed and board-certified level of expertise. I got certified in 2009 and had a chance to meet everyone for the first time at our annual luncheon that fall. I was surrounded by the rock stars of health care design. There is such a high level of thought leadership among our certificants. I joined the education committee, which I eventually chaired before serving on the board of regents. I’ve had the opportunity to be part of several committees and initiatives, including chairing our Legacy Project Award, helping to plan the Summer Leadership Summit, and being a liaison for the communication and exam committees as well as being treasurer.

What are some of the initiatives you would like to progress during your term? 

Like many organizations, we tend to spend much of our time in the health care design echo chamber. We are so busy talking to each other or our prospective clients that we forget that the average person has no awareness of how design can improve healing or support an operational strategy that gets them in and out of an appointment faster, or that facilitates them feeling empowered and being a partner in their own care. I am advocating this year that we strengthen our relationships with allied organizations like the American College of Healthcare Executives, the American Society for Health Care Engineering, the Center for Health Design and The Beryl Institute, but also that we reach out to adjacent organizations in the realm of public health, social justice, education and business.

How does ACHA add value to its members’ career aspirations? 

The ACHA credential signifies your expertise in health care design has been peer reviewed, tested and board certified. We’ve done an excellent job throughout our 20-year history of maintaining a high standard for achieving the credential. Now, we want to focus on ways to demonstrate that our certificants maintain that standard in their practice. Our continuing competence committee is identifying standards for expert-level continuing education and other channels for demonstrating expert-level competence. 

We are also looking at certification within the context of a career spectrum and identifying opportunities for those in the early phases of their careers to see a path toward building expertise. Finally, we are diversifying the ways that certificants can engage with us and contribute meaningfully to ACHA through task force initiatives and workshops. Not everyone can make the time commitment of joining a committee, but these additional touch points enable their talents to be harnessed. We also highlight two certificants each month, and encourage others to reach out to them.

How has ACHA helped its members respond to the pandemic?

Our organization has been a leader in advocating for infection control practices and adaptable design to address the pandemic. Four ACHA certificants were invited by the American Institute of Architects (AIA) to participate in the COVID-19 Alternative Care Sites Task Force, and one of them was recognized with an AIA National Presidential Citation for leading the task force and her public health advisory role in the AIA Reopening America Charrettes. In a survey of our certificants conducted in April 2020, we collected top recommendations and shared them in our organization. Recommendations included the need to pivot operations and design processes. We also promote articles written by certificants and have had many published that are resources for others. At town halls with our certificants, we asked them to weigh in one year later on the pandemic. We found that most of them believe there needs to be significant infrastructure investment and operational changes for disaster preparedness in health care buildings.

Has the pandemic caused any shifts in the approach to health care design? 

The pandemic was one disruptor that activated a sea change for health care. This usually risk-averse market was forced to rethink everything from patient flows to ramping up telemedicine efforts. Many of these issues are not new; they’ve been discussed for years and were often deferred as issues because they were uncomfortable changes. “Don’t fix what’s not broken” no longer applies as a maxim when everything is broken. I feel the pandemic gave health systems permission to experiment and be bold. In the chaos of the pandemic, health systems were compelled to do things differently and felt safer making radical changes than they did maintaining the status quo. 

How are other trends in health care continuing to impact the design field? 

Two major trends that are converging around health care design are the public health crisis and a shift to value-based reimbursement. Both require us to think beyond first cost and look at ways to elevate the human experience. While our clients are very comfortable thinking about construction cost in a project, or even life cycle costs and payback for sustainable investments, they seldom make the connection to the way that architecture can indirectly influence other items in their annual budgets. 

Evidence-based design identifies interventions that reduce falls, alleviate staff burnout and minimize hospital associated infections, to name a few. When we transcend design being a transactional encounter and instead see it as a lasting investment that will impact outcomes, we can have a different kind of conversation about construction funding. 

There also is a real cost carried through social determinants to health in low-income communities. Higher security costs, increased emergency department visits and higher hospitalization rates are just some of the impacts. Forming uncommon partnerships within the community to support employment, walkable communities and access to healthy food are investments that pay health dividends. ACHA formed the Future of Healthcare Task Force to recommend new health paradigms for care delivery, creating an equitable system and rethinking how we use space. Stay tuned for the task force report coming in late spring 2021.