ACHA president reflects on health care design field

The Moore File

CV

• Project principal, operations manager and project architect at The Haskell Company, Jacksonville, Fla.
• Registered architect in California, Texas, Oklahoma and Vermont.

Affiliations

• American College of Healthcare Architects (ACHA) 2023 president of the Board of Regents.
• Task force leader on the recently released ACHA “VA Task Force 2023 Report.”
• ACHA certified.
• U.S. Green Building Council LEED BD+C accredited.
• American Institute of Architects member.

Education

• Bachelor of Science degree in building construction from the University of North Florida in Jacksonville.

Clyde “Ted” Moore III, AIA, ACHA, LEED BD+C, this year’s president of the American College of Healthcare Architects (ACHA), discusses ACHA’s growing influence both within the health care field and internationally, as well as future directions and areas of opportunity for health care design professionals.

How long have you been involved in health care design, and what types of facilities did you work on previously?

My dedication to health care design started in 1990 when I was hired by Gresham, Smith & Partners. My experience before that included office buildings, military projects, schools and libraries mainly. My very early work was with a high-end residential architect, and I spent a lot of time detailing custom walls, stairs, millwork and kitchens. I became very interested in making sure all the details were considered and well-defined.

What attracted you to the health care design field, and how has it evolved?

When I started in health care design, it wasn’t long before I figured out that my design decisions were making a direct difference in the lives of patients and staff who relied on these facilities. So, I became a sponge to learn everything I could about the specialty to become better. I’m still learning about it today from nurses, physicians, hospital administrators, infection control teams, facilities managers, state agencies, engineers and the available published standards. 

The codes and guidelines available when I started were significantly fewer than they are today. When designing new facilities, this offered a chance to have more freedom to plan and design — even experiment. There was far less information available to tell if your design was best practice or not. That flexibility led to some successful ideas, but it could also lead to ideas that we would regard as not so good today. Designing today involves analysis and incorporation of the published data into our design goals. We try to design within codified requirements, guidelines and new research data.

The facilities we design today are more focused on patient safety, infection control, staff efficiency and patient experience. But today’s designs are still an evolution of what already existed early in my career. It is rare to see something that is entirely new on a floor plan, for instance. It is the attention to planning, design and infrastructure details that make a significant difference. Our craft is still evolving and refining, and is under constant revision for continuous improvement.

What have been your objectives as ACHA’s 2023 president?

My role is to make sure that we achieve the goals of our strategic plan, maintain our daily operations, and hold the highest standards in certifying and re-certifying architects in health care design.

The college will be celebrating its 25th anniversary in 2024, and our strategic plan has matured and evolved considerably. We are the one and only American Institute of Architects (AIA)-recognized specialty in architecture. That has made ACHA certification the highest standard in the field of health care design and planning recognized anywhere. We will continue to get that message out to potential candidates, health care clients, and the entire health and health care fields. 

If you are an architect who is dedicated to this field, pursuit of this credential should be part of your career path. We recognize that the process of becoming certified is not easy because the bar is very high. But we will continue to improve the process of becoming certified by providing more informational tools that help new candidates prepare for the exam. 

Our certificate holders have authored and published many articles, been a part of many national committees on codes and best practices, been involved with research and have presented many sessions at conferences. We will continue to promote, support and incentivize this type of giving back to the industry. 

Lastly, we hope to announce something important later this year that involves even more “giving back” to the field. 

How has ACHA been reaching out to the international health care design community?

Certification requires licensure in any U.S. state or in any country that is recognized by the National Council of Architectural Registration Boards (NCARB) with a reciprocity agreement. As NCARB continues to expand internationally, this will provide opportunities for more international growth in certification. Currently, NCARB has reciprocity agreements with Canada, Mexico, New Zealand and Australia. This spring, NCARB also will have a reciprocity agreement with the United Kingdom. We have had task forces looking into our growth into international markets, which can have language, units of measurement and cultural barriers. It is still evolving but, clearly, international growth is something we will continue to focus on.

What role did ACHA play in the American Society for Health Care Engineering’s recently published The Facilities Manager’s Handbook for Health Care Project Management, and what do you think of the publication?

At least seven ACHA certificate holders were involved in the development of the handbook. Based on the portions of the book that I have seen, it looks to be a great resource for so many people in the field. We look forward to our certificate holders being continuously involved in future revisions and updates.

What changes do you see in the future for the health care design field?

I believe we are at a critical point where health care costs are just becoming too high, there are shortages of key staff such as nurses and physicians, and new technologies are starting to change how we support population health. Virtual and mobile delivery of health care services will accelerate and expand with new devices that can provide reliable health data. Artificial intelligence will analyze this data and make triage and clinical decisions to a certain point before it will hand off to a medical clinician. 

I also believe that it is time to incorporate much more system automation and robotics into the health care setting and not just in certain rooms. It needs to become a partial solution to the nursing and staff shortages in clinic and acute care settings. Transporting of patients, supplies, linens, trash and biohazards as well as basic floor cleaning will be handled by robotic sleds. Additional robotics will help at the patient bedside and in treatment rooms. Nurses will be enhanced with on-demand deliveries as needed when they are with the patient, rather than having to seek them.

Wearable technologies, even in the acute care setting, will reduce the need for staff to manually collect blood glucose levels, blood pressure and patient temperatures every few hours, again reducing labor needs. I can see physician rounds in hospitals being performed with robotic virtual devices for efficiency, cost reduction and with a side benefit of reduced exposures to infections. With personalized medicine now utilizing genetic information for special treatments, we may even create new types of treatment areas in outpatient and inpatient settings.

Lastly, the efficient use of energy is already affecting inpatient and outpatient facilities significantly under the latest energy codes and modeling. As we move toward our 2030 goals of meeting the AIA challenge for carbon-neutral buildings, this will also continue to greatly impact design. We are already starting to eliminate fossil fuel-based systems, and we are moving toward high-efficiency electric systems, fuel cells, on-site solar and wind generation, and possibly geothermal exchange where it is available. 

It is a challenging shift, and health care architects will need to help lead these changes over the next two or three decades. 

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Michael Hrickiewicz is editor-in-chief of Health Facilities Management magazine.