Rural hospitals are not prepared for the pandemic. Here are NBBJ Design's ideas on five design and planning strategies rural hospitals can take now to adapt. #covid19 #ruralhospitals #pandemic #forbes

We had a conversation with Modern Healthcare about hospital systems that have not yet been hit by a surge in COVID-19 cases, or those that could face another in the future and what they can do to prepare. This is hitting the whole country, but it's not spiking everywhere at the same time, which allows for some great planning options in terms of supplies, equipment, or staffing. The one thing that hospitals should be doing is making sure they are filling out the paperwork for the preparedness relief from FEMA. Read the full article here. #modernhealthcare #surge #ruralhospitals #communityhospitals #covid19

Studies show space can affect mental health outcomes, from lowering stress to increasing creativity. The Behavioral Healthcare Executive podcast hosts NBBJ’s Richard Dallam and Tammy Felker, AIA, ACHA, RN, EDAC, LEED AP BDC to discuss the role behavioral healthcare design plays in transforming clinical outcomes. Click here to listen. #behavioralhealth

NBBJ's Bryan Langlands,Teri Oelrich and Janet Dugan speak to Modern Healthcare about the COVID-19 pandemic and solutions hospitals could implement in the coming weeks. Modern Healthcare's primary readership is our client base, with over 75% of readers being leaders in hospitals and clinics. #modernhealthcare #covid19 #hospitalsurge

The New York Times speaks with NBBJ’s Kelly Griffin on how the pandemic could shift the way we work in office buildings and the flexibility needed to do so. “The whole point of kinetic furniture was to bring people together,” she says. “Now it has a different function: to pull people apart.” #workplace #office #socialdistancing #coronavirus #covid19 #nytimes

For more information, email Ryan at rhullinger@nbbj.com. #prefab #covid19 #usarmycorpsofengineers

There was a clip a few years back of Professor Robert Kelly talking live to the BBC from his South Korean home when his two children walked in on him. Kelly's wife burst through the door to try to salvage the situation. The video went viral and the episode stuck in my head. It was hilarious and so so human and we all could relate. With COVID 19 on our doorsteps, we find ourselves open to similar-type follies while working from home.  Suddenly we are working with our loved ones close by who we enjoy spending time with on the weekends, in the mornings and at night but that middle part of the day where we have our own lives and make our own way provides an opportunity for us to get to know each other in a new way or in a new light! Sometimes it’s a way to strengthen relationships, or possibly flounder under these stressful times, but no matter what, it is guaranteed to leave us with some new working from home follies! Here are just three good old fashioned follies of the Reader’s Digest Laughter Is The Best Medicine type I’ve encountered in just the last few days of working at home. The Naked Truth Yesterday a friend of mine proudly sent me pictures of her family’s new everyone-working-at-home set up: Two kids working diligently on their school work at makeshift desks in the living room while my friend’s husband sat in the kitchen working away. Very smartly, her own at home office was set up in her bedroom safely tucked away from distraction! Or so she thought until this morning when she was on a video conference call and her husband decided it was time to take a shower! Just going about his business like any normal day, he undressed in the bedroom and sauntered into the bathroom…all happening in the background of her video call! Unplugged My own husband is also at home…just the two of us and our cats. I was listening to our Leadership Team talking about our plan as a firm, sharing next steps, and giving examples of those who are making efforts across the firm to improve their remote working environments and sharing tips and tricks. At that moment my husband decided it was really important to unplug the wifi. I’m still not entirely sure why he did it, but everything froze up and it took about 5 minutes to get back to the call! Doggie Downer Henri, a colleague’s dog, decided he was going to share the treadmill or maybe even just get some exercise on his own. Although no videos were taken, I’m sure it was a sight to behold when the poor pooch ended upside down! It would be great to get some of your stories for a bit of comic relief while we are all waiting and wondering what is going to happen next! Please add your stories to my LinkedIn and make someone’s day! #covid19 #remotework

Melissa Alexander and I recently had the opportunity to attend the GeoDesign Summit in Redlands, California. The summit was themed “Seeing clearly in 2020” with a focus on making smarter decisions for our planet. We joined thought leaders, innovators, and other visionaries to see firsthand how they are leveraging GeoDesign and technology to confront challenges head-on and plan for our future. We attended a variety of sessions over 3 days on topics ranging from homelessness in L.A to water scarcity in the Middle East. ESRI develops a wide variety of applications common to planners, urban designers, and others working at various scales of design. This year, we were excited to learn how ESRI has been focusing on integration with common AEC software like Revit, Infraworks, and Adobe. Over the next few months, we will take what we learned and focus on piloting these new tools with our own ESRI software. Stay tuned for a future BDIR or TechFriday where you can learn more. “The global crises of our time includes climate change; resource scarcity; massive migrations of our planet's inhabitants; and the challenges being faced by our local communities—strained infrastructural resources, economic exclusionism, and marginalized environmental quality. These cannot be solved with the same mind-set we had when we discovered them. Leveraging new understandings, approaches, and technologies will be essential in formulating a clear vision for turning the tide on these challenges and working toward a more vibrant future.”

This week on Thursday, March 19th at 12pm EST/9am PST, you can join this free webinar with NBBJ’s @Tammy Felker! This webinar is courtesy of the NIHD, the Nursing Institute for Healthcare Design. Tammy will be discussing the key principles for designing therapeutic and humane behavioral health environments. During this time when most of us are having to take advantage of working virtually – this is a great opportunity to take advantage of this free webinar to learn from and support our NBBJ family. More about this webinar: Behavioral health facilities have historically elevated the need for safety above the comfort of patients. Yet research shows that a calming, homelike setting with access to nature and views decreases stress and agitation and helps patients regulate emotions. This presentation will discuss principles to use that balance patient and safety needs when creating more therapeutic environments. It will include a high-level overview of how the approach to behavioral health facilities has evolved over time, as well as current research, design principles to create more humane and therapeutic environments, and resources for managing safety in this specialized patient care space. #webinar #behavioralhealth

I’m not a Gen-Xer, raised in a digital world where taking selfies are second nature. But I’ve learned over the last year how to embrace being on a virtual team and using telework applications. We all might need to do so sooner than later given the rise of social distancing requirements that COVID-19 is making necessary. Remote workers can feel more isolated than on-site workers and the risks of boredom and poor communication will grow with more self quarantining. So, whether you and your teammates are temporarily working remotely, or you find yourself on a geographically dispersed team, it is important to leverage great new tools that make working virtually seamless and successful. My favorites for virtual collaboration are Microsoft Teams and Zoom. I admit that at first Teams seemed confusing and an unnecessary added step to my daily work. But after diving in and changing my mindset a bit, I’ve discovered this really can be an entirely new - and possibly better - way to work whether or not you are at home or in the office. How to Be a Virtual Team Pro 1. Be seen: Get a webcam and use it on every single call or meeting and encourage, or insist, that your team members do the same. Who’s experienced the child that lasts less than two minutes on a phone call but could spend an hour on a video chat with you? Humans process visual information much faster and better than auditory, and video lets us connect on a personal level. When I see my team, the sense of distance is removed. Making virtual eye contact means closer connections. Zoom allows my team to easily connect, see each other and share visuals at the same time. To create the best video call experience: Make sure you have the light source in front of you to brighten your face Position the camera at eye level Use headphones for better sound Invest in a quality video camera for sharp images 2. Change to chat: Migrate most of your conversations and collaboration to a virtual platform like Teams, and stop using email for conversations Our inboxes rapidly fill with clutter, spam, and endless daisy chain email streams. Sometimes it can take hours to sort through everything. The beauty of team-based conversations versus emails is that you can join in on your terms – when you are ready. This allows you to have a one-on-one chat, a small group conversation, or a public discussion about a project or task. With a virtual team, the team-based chat is the primary communication medium. It is you stopping by your colleague’s desk to ask if they know how to do this or that. It’s working with your project team to solve a problem or collaborate on a deliverable. It’s offering quick kudos or support on their work. Here are my three best practices to optimize chat features: Use the @name feature to quickly get someone’s attention for important messages Save email for external or more formal communications Install the app on your phone – it’s so easy that way 3. Have fun: Reach out to your co-workers and teammates even for non-work-related reasons - whether it is a high five or a query about their weekend plans. Research shows that high levels of trust lead to better team performance, especially important in virtual teams. In-person teams rely on interpersonal relationships and face-to-face interactions: Water cooler talk brings us together, but our virtual world we need to come together in different ways: Be purposeful in reaching out to team members not sitting next to you Send a direct message (DM) Use the Teams conversation page to post a funny meme Throw a virtual party! 4. Learn new efficiency tools: Think about how you and your team can work simultaneously, seamlessly, and purposefully. Being virtual means you must figure out how to get work done, together. Collaboration can be tremendously efficient and effective because MS Teams integrates seamlessly with all Office 365 products. This point was driven home to me in a recent interview prep session when six of our team members were working on the same PowerPoint presentation at the same time! No more saving different versions of the same file and trying to merge them into one. Of course, virtual collaboration means new rules and protocols for achieving success. It took me a bit to find the shortcuts and the do’s and don’ts of collaborating in the cloud. At first it felt like a bombardment of distractions until I realized it wasn’t a technology problem so much as a boundary problem. Every notification does not need an immediate response. My suggestions include: Scheduling focus time Adjusting your notification settings Establishing the rules and norms your Team needs for working together 5. Unplug: Recharge, relax, and refresh in your off-work hours – whenever those are. With mobile devices and widely available Wi-Fi, it is so easy to be always “on” and constantly checking your phone - or even just thinking about doing so. Research shows it is important to unplug. We think we do this, but do we really? Thriving in a virtual work setting means setting clear boundaries: Use your status to let team members know when you are off-work Purposefully disconnect to engage with family, friends, and for personal growth Don’t forget to get outside; fresh air and natural light does wonders for your physical and mental well-being In just the last two weeks we have seen more companies, including my own, encouraging telework to help mitigate exposure to COVID-19 and making all of us part of the solution. Over the last year I’ve learned to master a number of techniques that make my remote work rewarding and productive. If you’re new to teleworking, these techniques will go a long way to ensuring your remote experience - and those you collaborate with - will be equally fulfilling. What about industries where it’s more complicated to work from home – like healthcare? That’s for another blog, but I’ll say one thing…. robots… Sources: 1. Grenny, J, Maxfield, D. (2017) “A Study of 1,100 Employees Found That Remote Workers Feel Shunned and Left Out “ https://hbr.org/2017/11/a-study-of-1100-employees-found-that-remote-workers-feel-shunned-and-left-out 2. Brooks, S., Webster, R, Smith, L, et al (2020) “The psychological impact of quarantine and how to reduce it: rapid review of the evidence”/ The Lancet. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30460-8/fulltext 3. Bigelow J, Poremba A (2014) “Achilles’ Ear? Inferior Human Short-Term and Recognition Memory in the Auditory Modality.” PLoS ONE 9(2): e89914. https://doi.org/10.1371/journal.pone.0089914 4. Vanderkam, L. (2014) Six Ways to Look Great on a Video Call. Fast Company. https://www.fastcompany.com/3026273/6-ways-to-look-great-on-a-video-call 5. Microsoft 365 Team. (2019) 5 ways to make group chats the best place at work. https://www.microsoft.com/en-us/microsoft-365/growth-center/resources/5-ways-to-make-group-chats-the-best-place-at-work 6. Breuer C, Hüffmeier J, Hertel G. Does trust matter more in virtual teams? A meta-analysis of trust and team effectiveness considering virtuality and documentation as moderators. J Appl Psychol. 2016;101(8):1151–1177. doi:10.1037/apl0000113 7. Paul, (2016) “Unplugging from work”. The Everette Clinic. https://www.everettclinic.com/blog/unplugging-work 8. Singer-Velush, N. (2019) Why unplugging from work is more work than we think. Microsoft Workplace Insights. https://insights.office.com/productivity/unplugging/ #NBBJConsulting #VirtualTeam #Engage #Remotework #covid19

How should healthcare systems across the US react as they develop long-term capital and facility plans? Source: The Center for Systems Science and Engineering (CSSE) at Johns Hopkins University - https://www.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6 Current State I am sure we have all seen the headlines, here’s the latest reporting (as of March 2, 2020): 89,000+ confirmed cases worldwide, 3,000+ deaths and 45,000+ patients recovered China constructed two temporary hospitals adding 2,600 patient beds in the city of Wuhan The COVID-19 virus, the scientific label for coronavirus, has unique aspects that scientist around the world are studying: It initially appears that the virus has a lower mortality rate compared to SARS and MERS but a higher infection velocity or R Naught value CDC recommends avoiding travel to ‘Level 3’ countries, China, South Korea, Iran and Italy. Currently, Japan is the only ‘Level 2’ status Human trials for treatment are currently underway at University of Nebraska Medical Center When compared to other historical disease outbreaks, the Coronavirus is not as infectious as other diseases (Measles or Small Pox for example) and still has a wide R Naught range (1.4-4.08), this could evolve as time passes and more data becomes available. R Naught: ‘The basic reproduction number (R0), also called the basic reproduction ratio or rate or the basic reproductive rate, is an epidemiologic metric used to describe the contagiousness or transmissibility of infectious agents’ Source: University of Michigan, School of Public Health: https://sph.umich.edu/pursuit/2020posts/how-scientists-quantify-outbreaks.html Do Historical Trends Predict Future Events? With all this information available, as a strategic healthcare facility planner, one has to question – so what? Do historical trends of a new viral outbreaks every 2-3 years dictate future events? Should we follow China and construct massive outbreak centers? Or should we have faith that modern medicine, treatment, vaccines and hygiene practices will run its course? Until now, Bird Flu, MERS, SARS, ZIKA and Ebola outbreaks have been out of the headlines for years… many would not expect that in 2019, there were still 30,000+ ZIKA cases worldwide. How Should Such Events Impact Long Term Healthcare Capital and Facility Planning? As we partner with clients across the country conducting strategic master facility planning, we study local, regional, state and national trends while sensitivity testing future scenarios to drive future capacity, space, and capital needs. We work with our clients to create alternative operational and facility-based scenarios to meet these future strategic or market needs and often do come across episodic events that create a paradigm where data, trends, and models can only get you so far. Enter COVID-19. From a facility-capital strategy viewpoint, I see the facilities China has constructed and wonder: How is the quality of the structures? Can they be long-term investments? What will be the maintenance and upkeep cost? Can they be used/repurposed after this event has subsided? Could other facilities have been repurposed to provide equivalent capacity? As we are currently not experiencing the infection levels that triggered the decision-making pathway that Wuhan has pursued, I would like to believe there are more cost-effective pathways the US can pursue to mitigate extensive capital expenditure and future risk. Here are a few ideas that come to mind: Following the 2016 Ebola outbreak, 55 hospitals across the country were designated as ‘Ebola Designated Treatment Centers’. Such facilities should be studied, how these isolation rooms are being utilized today, whether we can use them for this outbreak, and the effect it will have on hospital operations. The United States is quite capable of erecting emergency facilities the way China did, but will that be necessary? We have mobile military hospitals ready to deploy as needed that could be considered as viable resources. Most hospitals are required to have an emergency disaster plan that could incorporate designated treatment positions over available/adjacent space. Could such facilities handle COVID-19 patient activity, and if not, could specialized equipment/resources be provided to support such a conversion? Hospitals, assisted living facilities and nursing homes continue to close across the country. Can we use existing infrastructure assuming we can properly contain and managed possible close proximities to neighboring communities? These may or may not be feasible actions to undertake, but as we work with health systems across the country, we must consider the role of the health system and the market dynamics. We do not expect every community hospital in the country to be equipped to handle such episodic events, but regional or quaternary providers in metropolitan markets should absolutely have or begin immediately considering alternative solutions for such events. With all the unknowns about COVID-19, the next few weeks and months will be quite telling. I must admit, every morning I check the Johns Hopkins Coronavirus dashboard out of curiosity. I recall in 2016 while studying the ongoing Ebola outbreak reading an article analyzing the potential of the next ‘super virus’. The article described key traits of the likelihood of it being zoonotic (transmitting from animals to human), sourced from a mammal species, known for living in close proximities to humans and in an area of high population densities. The article identified areas across the world that meet these criteria…the comparison to COVID-19 is quite uncanny! Thank you for reading, -Chris Vishey Sources The Center for Systems Science and Engineering (CSSE) at Johns Hopkins University - https://www.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6 Center for Disease Control and Prevention (CDC) - https://wwwnc.cdc.gov/eid/article/25/1/17-1901_article Center for Disease Control and Prevention (CDC) - https://www.cdc.gov/coronavirus/2019-ncov/travelers/index.html Center for Disease Control and Prevention (CDC) - https://www.cdc.gov/zika/reporting/2019-case-counts.html World healthcare Organization (WHO) - https://www.who.int/emergencies/diseases/novel-coronavirus-2019 National Center for Biotechnology Information (NCHI) -https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4809931/ Pan American Health Organization (PAHO) - http://www.paho.org/data/index.php/en/?option=com_content&view=article&id=524:zika-weekly-en&Itemid=352 Nebraska Medicine, University of Nebraska: https://www.nebraskamed.com/ University of Michigan, School of Public Health: https://sph.umich.edu/pursuit/2020posts/how-scientists-quantify-outbreaks.html Forbes - https://www.forbes.com/sites/ninashapiro/2020/02/22/sex-does-matter-when-it-comes-to-coronavirus/#77397190a436 #covid19

A Conversation with Tammy Felker, Registered Nurse and Architect, NBBJ Editor’s Note: The number of people reporting behavioral health issues is on the rise, a crisis often compounded by lower-than-average funding, a lack of psychiatric beds and high occupancy rates of behavioral health facilities. This week we are posting interviews with experts in behavioral health, following an NBBJ-hosted panel discussion, to learn how different parts of the country are addressing the crisis. NBBJ: You plan spaces across specialties, but you are especially focused on behavioral health facilities. Given your expertise, how should these spaces evolve? Tammy Felker: In the past, behavioral health spaces were designed like jails and featured prison-grade materials, such as tamper-proof lighting fixtures and plumbing. As a result, these environments feel institutional and cold. Thankfully a shift in mindset is starting to transform the industry, creating a normalized care experience so patients feel safe, but also valued. Fixtures are becoming less institutional-like, and there’s a holistic emphasis on providing warm and therapeutic spaces. One specific area we’re investigating is the integration of circadian lighting. Regulating sleep-wake cycles is especially important to the behavioral health population for healing, and it is ripe for further study and analysis. What are the most impactful changes that could be made to how behavioral health spaces are designed? The first change is to rethink spatial density. Studies show that too many people in a small space can increase aggression. In behavioral health centers, giving enough square footage beyond the code minimum, so everyone has their own space, can make a difference in creating a normalized environment. Another is to provide room for physical activity, from yoga to treadmills. Research demonstrates the positive benefits of exercise on anxiety and depression. Current building codes for inpatient behavioral health units don’t require exercise areas, but as a result, they are missing a great way to support the link between lifestyle choices and behavioral health. A third element to consider is nature integration, ideally with access to the outdoors. Design that addresses our primal connection to nature can help decrease blood pressure and the use of pain meds. Even an area for horticultural therapy and opportunities to take care of plants can help. Why should investments in treatment and design go hand-in-hand? Our spaces and places convey meaning, and it is crucial that we send the message that behavioral health patients are valued. In fact, it may be more important to have a well-designed behavioral health facility than a typical healthcare space. That’s because behavioral health patients typically spend very little time in their bedroom and are constantly interacting with staff and other patients. Meals are usually in a group setting, and there are different therapy sessions, from art to group to individual sessions. Design needs to be supportive of this treatment model. What makes you hopeful when it comes to addressing the behavioral health crisis? The first is the Affordable Care Act and healthcare parity laws that require treatment of mental illnesses just like physical illnesses — and that people can get insurance that covers behavioral healthcare. Funding to train more doctors, nurses and other staff that specialize in behavioral health is another. In Washington State, Governor Jay Inslee is proposing an initiative that puts funding in place for a new 150-bed behavioral health teaching hospital in Seattle, along with community behavioral health centers across the state.