Al Hanna:

We’re here with Brent Hussong , one of the industry leaders in planning and design in Chicago and currently with CannonDesign. So, let’s begin by having you tell us a little about your current duties and responsibilities are at CannonDesign.

Brent:

Brent HussongMy role as Vice President at CannonDesign is focused on strategic and facility planning. CannonDesign is a collection of integrated service offerings.  We offer Architectural Design, Engineering, Facility Optimization Services (FOS), the Modular Design+ and Blue Cottage of CannonDesign focusing strategic and operational planning well ahead of architecture design sequence.  I interface with that group frequently seeking to keep a toe in the planning camp, and a toe in the design camp.  For the past 30-something years most of my work has been in Facility Master Planning, Architectural Programming and Feasibility Studies.  I was introduced to healthcare by joining a small firm with about 90% of their design portfolio in healthcare at the time.  I was very blessed.  Don Able and Tom Ringham were the partners of that firm, and through their nurturing and insights I became infatuated with healthcare design and never looked back.  Their mentoring and understanding of healthcare design spawned alumni from that firm in a variety of healthcare planning & design positions across the country.

Al Hanna:

Blue Cottage merged with CannonDesign a few years ago.  I find that really interesting, maybe you can provide a little bit of insight on how you collaborate. What delineates what Blue Cottage offers in forward-thinking type of philosophy or engagement as opposed to someone that’s doing healthcare facility planning.

Brent:

To answer your question, I view healthcare planning as the synergy of the care delivery and organizational business models. Blue Cottage provides expertise and techniques to guide Senior Client Leadership decisions focused on strategic direction and organizational effectiveness to implement that direction.  We often approach the issues from different directions but guide out clients to solutions that are both strategic and implementable at the same time.  Together, we support client in advancing their culture towards the strategic vision.

Let me, illustrate. From a strategic standpoint, a client may say, “we’re seeing a growth in the market with Cardiology? So where do we stand as an organization with Cardiology service offerings?” And a question strategically might be, “how should we restructure or who should we recruit to support the current physician network or enhance cardiology services?”  Bule Cottage expertise will focus on the operational and care delivery aspects and we integrate in how the form of the physical environment, provider & patient experiences, and infrastructure will support the advancement of cardiology programs.

Healthcare business model illustrating internal and external forces

There are a couple of perspectives involved here: care of the patient and culture of the healthcare organization.  One of the reasons I like healthcare is because it is complex. it has a complex organizational structure and a complex set of departmental relationships.  There are increasingly fewer independent departments.  For example, in the 1980s radiology and surgery generally performed procedures independently.   In current designs, there is much more integration of imaging and surgery.  Medical technology and techniques now provide platforms for image-guided surgery.  So, the surgeon has greater vision of the treatment sight and therefore less violation of the adjacent organs or tissues.  That has reduced patient recovery time.

I am anticipating more integration in the evolution of healthcare.  All healthcare departments are highly regulated by different organizations. It’s not just architectural fire life safety codes that are in play.  The planner/designer needs to understand the various regulatory agencies perspectives.  For example, the regulatory agency governing imaging modalities is different from the governing agency for a clinical lab. In that respect, it is complex from a technical and care delivery perspective.

It is also complex from an organizational perspective.  From that standpoint, as a planner, I am often asked by a client to prepare an analysis to determine the feasibility of a given project that is being considered.  My response is framed by asking two questions: (1) who in the organization wants this and (2) how to they intend to use it? Those two questions are critical to shape the methodology and deliver the most appropriate outcome.

Al Hanna:

And then you’ve got a, you’ve got a host of decision-makers, so the challenge is bringing together different departments that have different views, different needs, to build consensus. So I can see the challenge of that not being for everyone.

Brent:

It’s definitely not for everyone. Healthcare is a unique building type. If you don’t like a lot of complexity and topics that don’t necessarily talk well to each other, then you’re not going to be comfortable in healthcare. If you’re okay with that, and having all the plates spinning much of the time, then you’ll be very comfortable with healthcare.

Let me add one other aspect of complexity to healthcare design and planning.  Currently, most of my projects are in the United States and thus far, we have been talking primarily about healthcare delivery within the United States.  However, health and healthcare is very personal and culturally specific. Consider that when we are talking about healthcare, we are talking about personal lifestyle and values.  That immediately brings in not just health, but concepts of death. And there’s always a cultural bias regarding the meaning of death.

In the United State, there is a generally an ongoing debate about whether healthcare is a right or a privilege. That is not typically the case in countries where health care is provided by the government.  Beyond care delivery, reimbursement for healthcare services is regulated by the Government where it is delivered. In countries where healthcare is provided by the government, such as Canada, the payment structure has a more direct relationship to how the care will be delivered.  Understanding how care is reimbursed, delivered and received within the community and knowing how to tell the culturally appropriate stories is important.  That is not unique to healthcare.  It is a critical aspect of the design and planning process.

Al Hanna:

You mentioned your notable work here, both domestic and international type projects. What stands out over the course of 35 years in the industry, of things that you regard as highest achievements, most significant accomplishments.

Brent:

I would offer two projects that are the significant.  Let me first say, in addition to planning and design expertise the vision and engagement of the Client is a critical success factor in creating successful, innovative and, in your words, “notable projects”.

Okay. The first one to bring up is the most recent major addition to the Rush University Medical Center in Chicago, Illinois, designed when I was with Perkins and Will.  While I did not do the master planning there, I was responsible for developing the logistics planning (supply chain, food service, central sterile, etc.).  I was working with a team of about 18 different department representatives and one of our success measures was the flow of products through the facility; how are these products received, distributed to point of use, waste products collected, returned to the dock and exit the building.  The goal is to accomplish this flow without any disruption to clinical procedures (essentially without anyone noticing).  For the most part, the logistics functions are not considered very exciting.  However, the Rush project was progressive in many ways and once it became known there were robots delivering products throughout the new building, there was quite a bit more interest in “what was going on in the lower level”. The reason that’s an important project is not because of the robots, but it’s because of the Leadership vision and methodology for the project decision-making structure was organized. The design and construction teams were provided one floor of an existing medical office building on campus with the Office of Transformation: a small team of clinicians, administrators, and support staff with a single goal: deliver the new building and transform both the campus and the organizational culture to deliver the most progressive care in the nation.  There are several innovative and visionary features of the project.  However, in my opinion, the fundamental reason for the project success is that the entire project team internalized the project Guiding Principles.  Every one of those departmental representatives I mentioned, discussed the pros and cons of the various issues and often state one of the guiding principles for why on option was better than the others.  Senior Rush Leadership empowered the Office of Transformation and through disciplined principle-guided decision-making, the campus culture evolved and the physical environment reflected the pride of innovation within.  Hands down; it is a great project.

One of the issues in strategic planning is maintaining client confidentiality. The other significant project I want to mention is a replacement hospital for a confidential client located in the Midwest.   I directed the planning aspects of the project team, leading process improvement, master planning and architectural programming from project inception through delivery of the design development phase.  The project incorporates several visionary operational concepts.  I can’t share much about the details because it’s still under construction, but the design leveraged some great insights about how the organization will engage patients before they even get to the site and then once on site, how they will manage them, move them to their destination, deliver care and help them leave with a sense of wholeness and inspiration using a combination of human interaction and technology. It is very inspiring to work with a client team with a baseline of “what’s been done before” and seeking opportunities for where they want to push the ideas forward.

Preliminary planning concept for a hybrid operating room

Preliminary planning concept for a hybrid operating room

Those two projects were very satisfying, because the clients were very engaged and worked hand in hand with the planning and design team to articulate the vision. They were very inspirational.

Al Hanna:

Let’s say in the last project you mentioned that I’m going in to have hip replacement surgery. They’re reaching out to me in advance to do what?

Brent:

Well, whenever you initially engage the system, you would probably schedule your first appointment online or on your phone. When you arrive on campus, if you weren’t pre-registered before you got there, then you may move directly to the location of your procedures, or you may register at a kiosk, or if you’re really uncomfortable using technology, then they have a person that will guide you.  However, one of the organization’s great process improvement insights was to leverage technology but make it personal.  Hospitals are often intimidating.  You can easily get lost in a hospital.  So, one of the features they intend to implement is once you register, you will receive either a QR code on your phone or a wristband. At that point, the system knows who you are and where you want to go.  You walk to the elevator, scan the code and the elevator knows where you want to go. So, you know, if you’re the only one in the elevator, then the elevator only opens up at that floor of the your destination. It’s like “Google Maps” specific to you and the healthcare facility.  It builds patient trust through wayfinding but also helps with facility security. Thereafter, the follow up is monitoring or engaging in virtual visits through provider calls to the patient and/or telehealth conferencing.

Al Hanna:

Let’s tap into the philosophical side of you for a moment. We both are fortunate to have survived 2020 and COVID’s impact, but many did not. How well prepared, were we for something like this? And then the follow up, what did we learn that might prepare us for  the next pandemic?

Brent:

It is interesting that in a 2015, Bill Gates delivered a TED Talk1 warning that the next global health crisis would be a significant event.  It is obvious that we were not prepared as we should have been.  Some institutions were much more prepared than others.  Once again, it has to do with leadership’s vision.  A few years ago, I was working on a project that had a very visionary CEO and it happened to be at the time when Africa was struggling with Ebola.  In that case, the disease was contained more or less to that continent.  Ebola a devastating disease.  The CEO I mentioned directed us to design the hospital with an Ebola suite in the Emergency Department and another within the Critical Care Unit.  The project was only recently completed but the point is, Ebola transmission is completely different from COVID transmission disease, which demands a completely different, more complex architectural solution to make it safe for patients and care providers. Because of the CEO’s vision, that community is prepared to address contact-transmitted pathogens. COVID transmits through airborne pathogens in many ways similar to SARS (another type of coronavirus).  Healthcare Leaders are challenged with protecting community health and balancing the capital investment.  That creates a lot of ambiguity about where and when to invest in uncommon and unique care environments.

To your question about what have we learned coming out of the current pandemic, I’m optimistic that health care leaders and boards of directors are going to want to further minimize their risk.  I frequently talk with my clients about risk, and how they want to address it with investment in facilities.  We are certainly seeing it in a greater embracing of investment in air controls because of COVID.  We are designing more negative air pressures rooms than are required by code, but also entire suites of rooms that may be operated in a negative air pressure environment if needed.  We’re seeing more respect for supply chain, because one of the bigger problems we had going into to the pandemic was the need for ventilators. It was not just that there were not enough out there. There was not sufficient facility capacity to clean them.  That is a place where the tragedy of this pandemic may encourage more “systems thinking” in healthcare planning  and design.

In the second quarter of 2020, we had several clients ask us, “how do we prepare for post pandemic operations.”  CannonDesign assembled a team of clinicians and subject matter experts from within our firm to prepare recommendations.  Their research and associated white papers have been shared with clients as needed to enhance designs and strategies specifically for each engagement2.  One of the observations I stated to a client was that I expect there is going be a trust issue. We’ll see how that plays out,  but I said, “people are going to be afraid to go back to the hospital. You’re a great institution, you’re very well respected in the community, frankly, in a region. And I said, but you’re going to need to rebuild community trust”.  I presented a document listing various aspects of trust with associated operational and architectural implications for each.  Often, it’s simple things like providing a place to wipe down wheelchairs in front of the client and incorporating intuitive wayfinding into the design.  Both are important in reducing stress levels and demonstrate how the healthcare institution values the community.

Al Hanna:

If we set the pandemic aside and now deal with the everyday workings of a hospital, what are some of the things that you’re planning that we could see as visions becoming reality  in hospitals?

Brent:

My work provides me with the opportunity to spend a lot of my time with senior healthcare leadership of great healthcare organizations.  Often, our team supports them in articulating their vision. That vision typically involves a combination of business plans and care delivery goals. Vision in healthcare organizations involves a diversity of perspectives.  Our planning team helps them synthesize, if you will, where they want to go, and then helps them understand usually how fast they can get there. You know, one can create anything reasonable and if you have unlimited resources. Most clients don’t. So, we must develop the vision in chunks. That’s where near term, intermediate term, long-term planning comes into play and where we facilitate client decisions to create the map for how to realize their vision. Sometimes the focus is business; sometimes it’s about strategic advantage; sometimes it is about emerging care technique and sometimes it’s about the physical environment to advance both.  Those are the opportunities on side of the ledger.

Client discussion of campus development options during a planning work session

Client discussion of campus development options during a planning work session

The other part of planning is understanding market limitations, or reimbursement rates or a physical environment that has passed its useful life for supporting contemporary care delivery.  Any one of those may delay return on investment or demand an alternate path to implementation.  That’s where planning team experience, creativity and facilitation skills come to the forefront.  As organizations and campuses evolve, we never have all the pieces and we it never goes exactly as expected.

With that in mind, to answer your question, one of the new themes is resiliency. Resiliency   that is beyond sustainable/responsible design but resiliency of health networks, community wellness and accountability. I often hear Hospital Administrators ask for flexibility in facility design.  They recognize that facilities evolve very slowly while the pace of healthcare evolves quickly and it is accelerating.   Coming out of the pandemic, I am optimistic operational reliability will show the value that investments in infrastructure and supply chain are essential to systems effectiveness and sustained resiliency.

Al Hanna:

One area that I hear in plenty of discussion on is behavioral health. What can you say about that, as far as where we’ve been and what we need to do to really address what we might be neglecting?

Brent:

CannonDesign is a national expert in behavioral health facility design.  Behavioral health has historically gone through interesting cycles of highs and lows for how that care is financed. I think that that’s probably the biggest limitation.  I recently heard a person state, Behavioral Health will be the next pandemic.  It is well documented that the COVID crisis has elevated stress levels and the resulting long term social implications are yet to be seen.  There have been great advances recently in the community understanding of what mental health means and that’s good. I think there is a lack of priority for how care is funded, i.e. government policy and that’s a piece that is lagging behind the need. From a physical environment standpoint, behavioral health design is driven by level of acuity and there is a wide range of physical requirements from “calming” paint colors to anti -ligature devices and detailing.

Again, I’m optimistic that what’s emerging is a recognition of the social impact if we do not increase community behavioral health care.  Once governing agencies and healthcare providers can gain appropriate funding for community programs and specific facility projects, it’s our job as planners and designers to create those robust environments to reduce fear and increase joy. Not just in clinical settings, but in community action. Design professionals are called to create better communities on an urban scale that reduce stress and encourage people to flourish and live better lives.

Al Hanna:

You said something very interesting. You brought up the trust factor of patients coming back for elective surgeries. So, what are your clients telling you now for 2021, that might impact some of the revenue they’re anticipating? Do they see this coming back 100% in 2021? Or is it much further projections in that?

Brent:

From what I am seeing in the industry, the return to pre-COVID patient volumes will take more that a year. It depends on the department, but I think overall, there is recognition of patient reluctance. A lot of people have been putting off elective and even some critical clinical procedures but now they need them and so that’s going to create a certain surge that will balance itself out.  I am interested to see if the U.S. population changes the way they access urgent care or emergent care.  If patients change the access point to a health system, how would that impact other diagnostic services and would that create new avenues to further advance community health factors and outcomes?

Al Hanna:

Now Brent, we’ve really tapped into your depth of experience and knowledge along with the variety of hospitals you’ve worked on. Let’s focus on young architects now that want to be the next Brent. What advice would you give to somebody new to the industry or even at that 10-year juncture. Someone that really has a passion for healthcare and assisting others in time of physical recovery. How can they become the next thought leader?

Brent:

Number one: be a person of integrity. The products of a design professional have a significant impact on society.  As a result the ethical stature of the design is critical to the design’s contribution to society.

I suggest, it is essential to be continual learner because, like I was saying, the rate of change keeps accelerating.  It is also an advantage to understand empathy and how to facilitate discussion with different personalities, cultural biases and mindsets. I’m trained as an architect, but I have focused most of my career in planning and I make a big distinction in between the two. However, a success measure for me comes from creating a robust and symbiotic relationship of both. In my opinion, the media of architecture is space and the media of planning is time.  Where an architect may mature through increasingly deeper understanding of form, a planner may mature by seeking to become more adept at understanding implications from varying scenarios.  One of my mentors told me, planning is like walking backwards in time. We want to always look at the past and learn from it, but we’re still moving forward.

Al Hanna:

I like that illustration.

Brent:

The quote is from Les Saunders, an architect and planner in Atlanta, and it helped me understand the value of perspective in planning. I’d also say, it wasn’t that hard for me to move from architecture to planning because for my undergraduate thesis project. I was exploring, “what’s the first decision and design.”   It changed the vector of design.  Instead of looking at “when is the design finished,” it had me looking in the opposite direction, and asking, “what creates a project?” That led to, “How far up in the clients’ decision making does that need to happen?” This type of approach considers time as a variable rather than a constant.

But the point is whether you are advising a client at the inception of a project or creating a design to fulfill a client vision. Any young professional in a consulting role would be wise to adopt a servant leadership model. As you know, maturity involves understanding yourself first and your strengths and weaknesses, but recognizing your value really comes from what you contribute to others. That moves the contribution of the architect, designer, or planner to be an ethical obligation.  Healthcare planning and design makes those decisions very real.  I know my work contributes to community health.  While we work in teams with diverse skill sets that are constantly reviewing quality, I also know that if I make a mistake, it can be life-threatening.  I tell young graduate architects that when you when you pass the AXP exams and you go to receive your architecture license, you raise your hand and you promise that you’re not going to kill people with buildings.  For healthcare facility design, take that seriously.

Team member contributions to advance a project may occur in unexpected ways

Team member contributions to advance a project may occur in unexpected ways

Al Hanna:

Also, how can someone measure their advancement and expand their circle of influence?

Brent:

It has to do with contributions and credentials.  Contributions you make to advancing yourself, the project roles you are assigned (big or small), and the places where you quietly “lend a hand,” volunteer and inspire others are where you create your legacy each day. Regarding credentials, I recommend achieving accreditation from the American College of Healthcare Architects and joining one of its many work committees.  While credentials may incrementally change what you do and how you do, their value is in elevating credibility that opens the door to show your integrity, your vision and what you can provide to address the client’s needs.

I would also suggest that being deliberate with where you want to work is important.  Accepting an offer to join a firm is a relationship and the firm alignment with your personal values, portfolio and culture will significantly influence your career path. I have been fortunate to be employed at several great firms in my career.  I gained something of valuable from each experience.  I will say, CannonDesign is the best place I’ve ever worked from a cultural standpoint. It’s not just the knowledge bank of this firm, it’s the collegiality and the leadership that is continually inspiring.

Finally, consider your legacy.  Write how you want to be remembered at the conclusion of your career.  Be deliberate in charting your career path. What do you think you can accomplish? What are the steps you need to get there? How do you leverage that as you move up? Not just from a business standpoint, but from an ethical obligation to do better things.

Al Hanna:

That’s quite a jewel to drop. Thank you for sharing that, anything else you’d like to share Brent, as we wrap things up?

Brent:

You know, obviously, I love what I do. I really appreciate the opportunity to talk about it.

Al Hanna:

Fantastic. Well, Brent thank you so much for spending the last hour here in providing insights into your experiences and career. I’m sure everybody reading this will have an opportunity to consume great insights and knowledge that they can walk away from to assist in managing their careers. This is really one of the key points of, Leaders Shining a Bright Light series to illuminate for others a path to follow. So that’s terrific, thank you again.