JENNIFER ALIBER: When I think about health care architecture and wellness, I guess what I want to break it down into a couple of categories. So I think the thing we have learned most over the last 15, 20 years are things that in terms of patient healing and well-being, almost all of which also apply to staff, are things like access to daylight. Although I must admit, when I do go on site to look at hospitals and I walk up on nursing units, the curtains or the shades are always down. 

So I actually think most patients who are inpatients really prefer twilight. They're kind of snoozing. They don't feel great. So-- and I don't think anyone wants to admit this -- nonetheless the access to daylight's really important on the day you feel well. It'd be great if we had daylight for every patient who comes out of recovery to know they made it. 

So I think that's even-- that's probably the number one thing in terms of thinking what makes a difference for folks, maybe right up there would be acoustical privacy, meaning is it quiet. Can I sleep? And I think most of us probably had grandmothers or moms who said, you know, if you're not feeling well, just go to sleep. Sleep will really help you more than anything else. And I think they were largely correct. But I do have clients who say, it's so tough. We got rid of 90% of our noise. 

So now there's no clickity clack of the dietary card. People have learned to soften their voices. But then someone will hear a door close 40 feet away, and that annoys them. So we're making progress, but there's still these little things that matter. 

Well, we're certainly thinking more about the interests of staff. I don't think we've been very imaginative in our responses beyond that the staff lounge on a nursing unit, for instance, has a window. I like to locate them just off the unit so that people can go in there and laugh. And I think it's how can I relax if I know next door to me if the family where Mrs. Smith isn't doing very well, and Mrs. Smith's husband shouldn't hear us sing happy birthday to one of the nurses. 

So I actually think a little removal make sense. But once we get beyond the lounge where I can actually have access to daylight and a computer and heat up the lunch I brought from home, I don't know what else-- I don't think we're having a broader conversation about what staff really need or want or what-- and what would make a difference to them. And I think we need to do that. 

On the diagnostic and treatment units, OR floors, where we may have scrub nurses in an OR setting for 12 hours, we also try to get at least daylight somewhere where they-- along a corridor, so they can tell it's a sunny day or it's a rainy day or it's day or night. And I think that makes a huge difference probably even more than the staff or on nursing units. 

I think the next emerging thing is going to be wellness. And I struggle a little with the language. But I think that example of the Bronson Healthy Living Campus because as the financial pressures to keep people out of hospitals increase, then the entire community has to think more about what does it mean to be healthy. And if the major signifiers or major indicators of health are really education, which leads to a job, then I think we're going to think as broadly as possible about what that really means. So do people have access to jobs, which in some ways means do they have access to education or at least their kids. 

And from an architectural perspective, I think that means how do we think beyond the hospital? And that's where the issue of hospitality, and I think of hospitality extending really to include retail more broadly. I don't quite know how a minute clinic kind of environment or urgent care environment deals with hospitality. But I think there are parts of that they do. Certainly the issue of how long do I wait as a customer because if I think it's unimportant, then I'm going to have very little tolerance for waiting. 

So what I see in these urgent care centers is I can drive right up. I can look in the glass. And I can see if there are a lot of people waiting or not. But I think we're going to see an explosion of different ways of thinking about more broadly about wellness and healthy and not the hospital. 

I think it's fascinating that in the US, we don't distinguish between a hospital for sick people, meaning they have an infection of some kind, and a hospital where people are getting fixed, orthopedic. And if we're dealing with these issues of infection control, I actually think some of the international models of separating makes sense. But that said, I think the hospitals themselves are going to be not all that different. But I think it's everything that happens before I get in the hospital and after I get in a hospital that's where the action's going to be. 

That said, I think we're going to see versions of day hospitals. So let's imagine an 87-year-old woman. She's had cancer on and off-- and maybe even-- maybe 78's a little-- 87's a little old-- wakes up one morning, doesn't feel that great. So right now the options are I call the ED, the emergency department. That's probably a terrible place to go because they don't understand chemotherapy. 

I could call-- she can call the cancer provider, whoever her provider is. But she-- what-- it's not really their daily business. They've got a full slate of patients to see. So I'm hearing of some clients saying, come on in, Mrs. Smith. We'll tweak you. We'll see are you really just dehydrated, make sure you're taking the right meds and the right dosages because it's often an issue of the side effects not the actual treatment itself. And right now, the reimbursement and financial model doesn't cover that. But it does probably make sense for that patient to go with the specific nursing care is available. 

And as some of these patients are going to be older, it's a hard thing to do at home. It's going to be hard to send the nurse who really understands the side effects of some of these-- all these medications that are complicated. So I think we're going to see some really interesting interventions even for patients who weren't staying the night but may need the benefit of really specialized care. 

The issue of interdisciplinary care and team care is actually, I think, one of the most interesting changes in health care overall. And in fact, even the nomenclature what we used to call a nurse station on an inpatient unit is now often called the clinical station, or I like to call it the team station and make it really clear that the team can be anybody. The team might be environmental services and not just clinical care because that patient may need it-- there may need to be a different cleaning regimen in that room. 

It's fascinating to me that Banner Health has just purchased the University of Arizona Health Network, which means they now have direct access to the University of Arizona medical school. And I'm-- they've been pretty public that one of the reasons they were interested in that was having access to that clinical workforce in future decades. And it's not just doctors, and it's not just nurses. It's pharmacists. It's the broader team.