Podcast Transcripts

David Cummins: You're a hundred percent right. I was on one site once and these two 19 year olds, they were pushing plasterboard and I think their OHS rule was you're allowed to have five per cart. They had 20.

Yeah, had long story short, it came outta their Alimak and crashed his leg and he broke his leg. Just silly stuff like that. And then I was on another site where it was five, took longer, but that was what the rules were, and it took longer and he didn't crash his leg and it worked fine.

So you're a hundred percent right. There are rules in place and PE people want to cut corners where they'll get caught eventually. So I do think there are tremendous benefits in in having that as well.

How important do you think leadership is where decision makers are educated about the importance of women in the workplace, in the construction industry?

Sarah Holdsworth: I think leadership is really important, and I think leadership needs to come from all levels of site. I don't think leadership just sits with upper level management. Leadership needs to be shown by all stakeholders working on site, but also working around site. So all stakeholders associated with the construction industry need to be part of making changes that crush this gendered stereotype.

So, With the research that we undertook last year where we interviewed 43 women working in trades and semi-skilled work, we identified that a lot of the women that were working onsite found that they were not supported, and our lack of support was exhibited from management, from colleagues, from all different stakeholders out onsite.

So we need leadership in terms of, you know, people need to take on the responsibility to lead by their behaviours. So we need all people working on site to recognise inappropriate behaviours when it occurs. So when women and men are experiencing inappropriate verbal behaviours or inappropriate physical behaviours, we need people to call it out because one thing that we found was one of the key barriers that had a really negative impact on women and the way in which they experienced inappropriate behaviours out on side was this culture of silence.

And that often when inappropriate behaviours were occurring, people of all levels just turned a blind eye. And so there was a real reporting from the women we spoke to of a culture of silence out on site.

So people failed to call out inappropriate workplace banter, they failed to call out communication that was overtly aggressive, they failed to call out inappropriate behaviours. And as a consequence, women continued to be marginalised and experienced feelings of isolation being ostracised, being belittled, being excluded and fearing for their own safety and also opportunities.

So I think leadership, in terms of speaking out when you see something that's not right, is super important. But coming back to the point about management, I'll never forget this story, a woman I spoke to recalled, she told me that she was on site and she was in a meeting with some workers from the site and a junior construction manager.

She was completely inappropriately spoken to, and the meeting ended and she went about her task and she said maybe 40 minutes later, that assistant construction manager came back to her and apologised for the way that she'd been spoken to, and he apologised on behalf of the employee that wasn't his employee, it was a subby, but apologised on behalf of the person said it was inexcusable and he felt really bad.

And she said to me that while she appreciated the apology, what really upset her was the fact that he didn't say anything as it was occurring. And my response to her was well, would it have made a big difference? And she said, unequivocally, absolutely if he had called out that behaviour, It would've ceased and it wouldn't have occurred again.

So it's really important that we lead by our behaviours. We treat people with respect and in a way that they deserve to be treated. In a workplace, but also as a person, but that we don't ignore it when we see it. We call it out, and we really live that practice so that the industry slowly evolves in terms of what is acceptable, normalised behaviour.

Because at the moment, a lot of women and men as well deal with unacceptable behaviours because it's just considered the norm and nobody says anything. And women, when they do speak out about it, recalled often being punished. So even though they're not perpetrating that behaviour, they're experiencing that behaviour, they get punished.

And women talk about fear of repercussions, and the repercussions that I've heard might be being stood down. If they're in casual work, they go to the bottom of the list and they've gotta wait till they get the top of the list to be called for shifts and they might be put back in the yard and not given work for a couple of weeks, they might become labeled.

And so they get a reputation as they move around job sites, because you know, in the industry we never stay on the same site. We're moving around jobs consistently. So as they move around, they get labeled as being a troublemaker, being difficult. And if you know you are one in 1,300 workers who is female, it's pretty obvious who you are.

So you get labeled and you're already feeling isolated enough. And then to have this label where people deliberately don't talk to you because you're perceived as trouble or talk to her, you'll get told off or you'll get in trouble.

So, policies and procedures for reporting inappropriate behaviours, showing leadership by establishing those policies is really important, but contributing to that change in culture of what is normalised and allowing people to freely speak up about incidences that have occurred without fear and without being persecuted, and then actually having some repercussions to those that have been exhibiting those behaviours.

Because again, the women that we've spoken to often found that not only were they punished, but the person that took that behaviour, there were no consequences. And that could happen across all levels and positions on site. So it could have been a senior manager, it could have been someone that's just come on the site for a day as part of a labor hire.

David Cummins: Yeah. And one of the problems that you've highlighted there is that was obviously an open meeting, but there's also the closed corridor conversations that are behind closed doors where people think, as Trump would say, locker a room conversations, where people would think they're not being listened to.

And I was on a site once where one of the managers and Subies were talking about females, but didn't realise the barrier was not acoustically protected and the female was next door and heard everything. It was reported to me, I was there, called out the guys, and they were thrown off site straight away because it's just not acceptable behaviour.

So on many levels, there's those discussions happening behind closed doors and in open doors.

Sarah Holdsworth: To your point about this locker room interaction, I guess that's another issue or another way of men communicating, that women have identified that isolates them, is that a lot of the time men talk in their social clique, which women aren't included in.

So it might not even be anything derogative, it just could be the fact that you've got a group of men on site that are all talking footy, and because you've got a female worker there, she won't be interested in footy, so she's not included. Or they go out to the pub for lunch and she's not invited, or they go on their golf days, on the weekends away and she's not included.

So it doesn't have to be something that is overtly offensive, it can simply be women are excluded from those social interactions. And that's really important because when you're excluded like that, you don't make the connections that you need to progress the kind of work that you're undertaking.

So a lot of promotions, a lot of job opportunities all come about through word of mouth, especially in the construction industry. Everybody knows somebody who knows somebody. And if you're not included in those conversations, You don't have the rapport or you don't have access to the opportunities in terms of different kinds of work or leadership positions.

And, invariably, a lot of the women that we spoke to, one of the things that they really want, aside from a workplace where they feel safe, Is a workplace where they're given meaningful work tasks.

And part of meaningful work tasks is being given the opportunity to do all the kinds of work that men do. And some of these jobs are quite coveted, so you need to be kind of in the in crowd to access, but also that if you want to take on a leadership role, you need to have the ear of the people that you're working with.

And in some instances, women explain to us that even though they were identified as the best candidate for a leadership position, because and this, you know, quote-unquote, because "the boys won't take orders from a woman" or from a girl , she wasn't given that leadership responsibility.

Or, some women reported managers, giving them lots of support and opportunities to go and do additional training and get additional skills. But because the work colleagues wouldn't allow her to undertake those tasks, you've got an issue in that you've got women being educated and upskilled, but not then able to pursue the jobs associated with those skills, and therefore you've got an educated, but maybe not experienced workforce as well.

David Cummins: Just before we finish up, your research is basically allowing to help create policy for the future. So what is that policy looking like at the moment? What do you think we can do to help and what's does society have to do to help overcome some of these issues?

Sarah Holdsworth: Some of the recommendations that we made were really about a systems approach because as I said, it can't be the individual and it can't be women trying to create change themselves.

 We need to have a systems approach where all stakeholders in the industry assume a level of responsibility for changing the way in which women are perceived and afforded opportunities. And I think for me, one of the really important things is this zero tolerance of inappropriate behaviour and inappropriate behaviour to towards women because as I said before, as a minority group, these things tend to exacerbate.

But in general, people say to me all the time, we've employed a woman and she wants to be treated the same, so we treated the same, and then she gets really upset and it's like, what are the behaviours that we accept as normal and are they really acceptable? Would I be able to behave like that in my workplace and maintain my job?

No!

So it's not that it's "the woman's fault", it's, we need to recognise what appropriate behaviour could and should look like. It's about adopting procurement practices where we require gender equality and opportunity in the workplace. So it's not just about saying, "okay, well we've employed this percentage of women on site, and then we put them all on the same task. We've got them all in traffic management or they're all sweeping with a broom".

We want to have women doing all tasks, whether that's management positions, trade positions, semi skills, and we want them of all stages of their career. So we want to have apprentices, we want to have trainees, we want to have just qualified, we want senior managers, we want assistant contract admin, we want women in all positions.

We want access, quality of employment and this idea at women of all stages of their lives are being able to access. Because one thing we found that was as soon as women started to consider a family, the idea was, well we'll keep working in the commercial sector perhaps that we're in and then when our children are a little bit older and we're ready to come back to work, we'll start our own business.

Now that's great if you're a tradeswoman, but if you're not a tradeswoman, what work practices do you go back to? So, flexible hours, flexibility in the workplace, and just a recognition that we need to create safe workspaces under our Occupational Health and Safety Act.

And that's not just physical. We need to have primary intervention measures that reduce all remove the psychosocial risk as well as the physical risk. And I think the other thing that's really important is we need to communicate the opportunities to women of all ages as well, because the majority of the research that I've undertaken so far really identifies the majority of women coming into the construction industry as an apprentice.

Or as a semi-skilled worker, often as a second career choice. Now, sometimes that's because these women thought trades might be good for them as a schoolgirl, but were told that it wouldn't be suitable because the culture wouldn't be suitable or the opportunities wouldn't be there.

So you've got a lot of trades women coming in as a mature age apprentice because. It was discussed that it wouldn't necessarily be the right fit, or as a school girl, you don't know what the opportunities are within the construction industry.

And we have a lot of mature aged women coming in as a second career into semi-skilled roles, looking for opportunities in the industry and helping identify those pathways into a variety of that exists.

So really showing women what they can be at all stages of their lives, but also showing what they can be. Because at the moment, the diversity of a opportunity is not well communicated for people to see to then enter, and then be retained.

David Cummins: Thank you for your time today, Dr sarah. We really appreciate it. Do you have any take home messages for our listeners today?

Sarah Holdsworth: Thank you, David for the opportunity today, and what I would just like to say on a more positive note is that the industry is slowly changing. There are more women coming into the construction industry and I think there are a lot of people doing a lot of work out there to try and ensure we slowly, slowly grow the numbers of women across all roles in the construction industry.

Progress is being made, but there's always plenty of opportunities for improvement. And I look forward to the day when I see many, many, many more women working in all roles in the construction industry as I drive or walk past construction sites.

David Cummins: Thank you very much.

If you would like to find out more about the One Hundred Percent Project, our research and listen to other podcasts, please visit our website, the100percentproject.com.au

thank you for listening.

G'day and welcome to the AHDC podcast series Health Design On the Go. Today we will be interviewing Sarah Holdsworth from RMIT University. We'd like to thank The One Hundred Percent Project for allowing them to share their podcast with Sarah Holdsworth, who has a deep dive into the research about women and construction industry.

Thank you to The One Hundred Percent Project, and we take it over from there.

David Cummins: Hi, I'm David Cummins from the One Hundred Percent Project. In this series of podcast, we'll be discussing gender diversity within the construction industry and how it has impacted the industry. We'll also be investigating the steps necessary for making improvements for gender equality in the future.

I'm talking today to Dr sarah Holdsworth from the School of Property Construction and Project Management at RMIT University. Sarah is an Associate Professor of Sustainable Built Environments and has spent several years in researching women's experiences in the Victorian construction industry with the aim of better understanding how women gain entry and experience into the industry.

The research seeks to provide an evidence base to inform policy and programs to increase the attract and retention of women in all roles across the industry.

Welcome Sarah. Thank you for your. How are you today?

Sarah Holdsworth: I'm good, and thank you so much for allowing me the opportunity to chat with you today and to speak to all your viewers about such an important issue that I and many others are so passionate about and hope to begin to, or continue really creating change in the construction industry with regards to women and their experiences.

David Cummins: Yeah, so speaking about that, a lot of the One Hundred Percent Project is actually based on evidence, which is one of our unique selling points. And I remember at university, I was always taught, what does the research say? But you've taken that one step further and you have actually done all the research yourself, which is very impressive.

So what actually motivated you to get into the research of such a unknown topic in the construction industry?

Sarah Holdsworth: As you mentioned in your introduction, I've been working at RMIT for a number of years and I've been working in the school of property construction and project management and I've been lecturing to future construction managers and project managers.

And a number of years ago some colleagues and I sat down and really thought about how important it would be to better understand and prepare our students for the workplace they were going to enter upon the completion of their degree.

And we thought this was really important as educators for us to give real consideration too, because we know the construction industry presents not only physical workplace hazards but also social hazards that can impact not only on physical wellbeing, but also its employees' mental wellbeing.

So through a lens of resilience, we sought to understand how we could prepare our students to enter or transition into the industry based on how prepared they were, as a result of the engagement around this notion of resilience that we are undertaking.

Now we thought resilience was an important aspect to really grapple with in the context of our students and their existing capabilities because we know that individuals with high levels of resilience are able to manage stress and anxiety and bounce back from adverse circumstances with often heightened levels of capability.

And we know that the construction industry is a workplace that can be characterised as high pressure having a poor work-life balance, individuals having limited job control, low levels of managerial support, and one that is hyper-masculine.

So we saw resilience as something that was really important for our students to have high levels in, to enable them to best perform as they work their way through the industry. Now, the research that we undertook focused on looking at our first years and our fourth years, how they transitioned in, how they moved across their degree program, and then also how they transitioned into that workplace.

And one of the great things about our program is the majority of our students are working by third and fourth year. So we were able to ascertain how prepared students were to negotiate some challenges and adversity as they were experiencing them in their degree, but also as that then translated out into their workplace experience.

And what we found was that as our students moved from their first year to their fourth year, as you would imagine, managing the stresses of university, coupled with the balances of work and working in a construction industry or a construction landscape, their resilience increased.

But one thing we did note, and we were quite surprised, and maybe we shouldn't have been, was that our fourth year female students had a high level of resilience than our male students did and their level of mental health had also declined.

And upon reflection, myself and my colleagues, Michelle Turner and Christina Scott Young, really sought to gain a greater understanding. And through some discussions and interviews with those students, you know, we recognise that, as is the case with all minority groups, their health outcomes are worse despite experiencing the same levels of adversity, than the majority of the population.

And so as construction educators and researchers, we sought to look at ways in which we could really think through learning and teaching practice to address this kind of gender difference. There's obviously a high level of gender disparity in the industry, but also in our classrooms because our classrooms are a microcosm of the industry.

And as we slowly began to grapple with ways to think through dealing with conscious and unconscious bias in our learning and teaching practice, we recognised that we needed to think more than just about the resilience of the individual because this issue is, and when I see this issue, when I'm talking about health outcomes dealing with adversity, it can't be on the individual.

It can't be just the female student or the female graduate trying to address a conflicting workplace that has negative implications to their resilience or to their mental health, or simply their workplace experience. So we sought to look beyond the idea of resilience, and we embarked on a body of research that looked at how women going into professional roles in the construction industry experienced the industry more broadly.

Not just their resilience, but you know, what were the antecedents to a good workplace experience? What were the barriers? What were the opportunities? What was the workplace culture like? And then recognising that women in professional roles are a minority, but women in trades and semi-skilled roles are even less represented in the industry.

We began to broaden out, not necessarily the scope of the research, but the population within which. We were researching, so last year we were really fortunate to get some funding from the Victorian Government to look at the barriers and the enablers of wellbeing for women working in trades and semi-skilled roles.

And as you said earlier, David, to really form an evidence base from which we can develop. Or we can make recommendations, what recommendations we might make to government or industry or industry associations or women themselves around ways in which we can improve the experience of women working in the construction industry.

And as you said, it's not just about attraction and recruitment, it's also about the retention of women because we want to see more women working in the industry, and as we get more women working in the industry, we can improve the way women experience the industry, and that will in turn then encourage more women into the industry.

And what we saw as so opportunistic and exciting from our perspective was the fact that we could talk to women based on their day-to-day experiences. So making recommendations not from what we think sitting back in university or from what a male construction manager might have observed, but actually talking to women about their day-to-day experience.

About the issues that they face, about the things that really work for them and make recommendations to support women based on the opportunities women have identified as informed by their experiences.

David Cummins: That's an amazing introduction. To be honest. At the end of the day, I've been in the industry for 13 years, and you're a hundred percent right if you don't identify what the problem is, you can't fix it.

And I personally have seen gender diversity and sexism and abuse and bullying in the industry personally and also towards my female colleagues. And those females generally don't survive then, you know, there are those people that stay, but if you can't identify what the problem is, you can't fix it. So what were some of the experiences that you're finding or the barriers that you'll find that really inhibited the fact that women didn't stay in the industry?

Okay, so we can talk about this from two perspectives. We can talk about women as they're attracted into the industry, and then what women experience as that informs their retention. Which would you like me to talk through first? I suppose it's an evolution, isn't it? Like you need to get them in first.

What attracted me to the industry is that I like the complication of it, and I'd like being outdoors, and I liked the team camaraderie, I like the problem solving. I don't think that's a male only desire to have that in the workplace, so I think that would be an attraction, but I don't know.

Sarah Holdsworth: So from the work that we've completed, talking with women who've graduated and are in a range of levels in professional roles with women working in trades and semi-skilled roles, and more recently with women undertaking apprenticeships and traineeships, we began to explore through our research what attracts them and then what are the barriers.

To recruiting those women. And then what does that mean in terms of their lived experience, in terms of their retention, and as you've suggested, similar to yourself wanting to work in a high paced industry, is something that attracts women to the industry, a varied workplace, really doing something tangible that contributes to society by way of a building or a piece of infrastructure that's going to contribute to the social capital of the communities within which they worked, but also an industry that is physical and also allows them to have a very tangible impact to perhaps their creative side or their problem solving side.

So women are attracted to the industry, as you've suggested, as you were for the same reason. But in terms of engaging, it's one thing to be attracted to the industry, it's another thing to then be able to recruit.

And from the work that we've undertaken, there still exists within the industry, a very strong gendered stereotype that construction is work for men, and that kind of work is not appropriate, it's not suitable or that women simply don't belong because they don't have the capabilities or because they just will be a disruption or they will be non-committed.

So women are attracted to the industry for all the reasons that you suggested, but gaining entry to the industry is something that is particularly difficult for women because of this ongoing perception that the work is not for them.

David Cummins: When you say not for them, are you talking about in from a strength point of view, a mental point of view, a sex point of view?

 What do you actually mean by that?

I'm in construction, but I've never lifted anything and I don't drive trucks, but I'm still in the industry, what do you mean by they don't have the capability?

Sarah Holdsworth: Obviously just recognising I am simply reporting what I totally have heard, so a lot of the women that I've spoken to, have been told flat out that women can't do a man's job because they don't have the physical strength or, to lift heavy pieces of wood.

So, not for them from a physicality point of view, and of course I'm not talking about everybody in the industry, but from the women we've spoken with, there has been a distinct narrative that questions their physical ability to undertake the tasks.

Then as you pointed out, there's also the issue that emotionally they won't be able to cope with an industry that's high pressure or an industry that can be quite conflicting.

You know, some harsh words can be spoken, it can be quite abrasive. So there's also concern that women don't have the emotional capabilities to manage in the harsh landscape and I'll give you a really good example of that.

I was speaking with an apprentice a few weeks ago and she described going for a job to make sure she was able to undertake her apprenticeship and she had multiple interviews, with her now employer, who was not necessarily concerned about her capability, because this woman had family members that had worked in the industry and ran their own businesses, and in the end, the apprentice offered to invite a family member to come to one of the interviews.

And the whole interview with the family member was about whether or not this particular person had the social and the emotional abilities to cope with the industry. So, a third person who was male had to come to give the potential employer enough courage to put this particular individual into that position.

There's also a concern that women will not be committed or not present because we know the nature of the industry is contract, we do shift work seven days a week, long hours, and it's fine to be young and single, but as soon as you come to the age of thinking about having a family, whether you're in a management position or in a trade, or a semi-skilled role, questions arise from the women I've spoken to about whether or not women as employees will be committed.

Why spend all this time training when they're just going to go off and have a family and leave the industry. And that's then also perpetuated by a lack of experience dealing with pregnancy in the industry. So people don't know how to manage a pregnant tradeswoman and, she shouldn't be managed, but, what work do we give a pregnant woman who's doing reasonably dangerous work at height or so on?

Do we have maternity clothes, how do we manage women in apprenticeships and in tafe, what do we do with women in terms of maintaining their abilities to continue studying on accruing the days that are required to successfully complete an apprenticeship?

And what does that then mean returning to work and how do we manage those hours with young children and family? And there's this assumption that women with kids will need to take days off when the kids get sick and so on. So there's these issues associated with gender that women kind of grapple more with than men.

And that is a question mark that poses a risk in which not all employees are prepared to pursue.

I would say in the construction industry, when I've had females on site, the site runs smoother, the aggression is less. There are tremendous benefits to having more women on site, and if people want to say men are generally more stronger than women, what I would say, women are also more generally organised than men, and probably to have a stronger emotional intelligence than men in the sense that I've been on site many a time where I've seen pushes and fights and had steel pipes thrown at my head.

At that level of aggression and lack of emotional intelligence, it's not acceptable in any industry and just because it's a construction industry doesn't mean it's accepted there and it shouldn't be accepted there.

So I would say as a, I'm not an employer, but as a potential employer, the benefits outweigh the negatives.

What is some of the benefits that your research has uncovered, which will no doubt lead to future policies?

From the women that we've spoken to, they have articulated the fact that once they're able to prove themselves, once they're able to show that they A, have the capability, and B, that they are committed and C, that they're motivated and they love their job, they then become welcomed.

And that's not in every case, there are some incredibly supportive workplaces out there and there are some women that have had amazing experiences, but there are a lot that have encountered problems. But they all identify, the women I've spoken with TAFE educators and employers, there's a recognition that once women are given the opportunity they're able to show that they have problem solving skills, they are able to bring a level of attention to detail that means the quality of their work is really high.

They're able to focus on tasks and multitask all at the same time, and they do bring a different dynamic to the workplace. But I think it's important to recognise that we shouldn't be employing women to change the culture of the industry.

There is a value add that once they are embraced, because they've had to prove themselves to be accepted, there is absolutely a recognised benefit. A lot of the women that I've spoken to have talked about the fact that they feel a level of pressure to prove to their employers that women can do it, and when they do, they see their employers employing more women because they've seen that women are as capable as men are.

There's benefits to having men on site, there's benefits of having women on site but the difference is women don't necessarily get the opportunity to show what they're capable of doing.

And to your point about lifting heavy objects and so on, we have an occupational health and safety act and that regulates that nobody should be lifting certain weights. Nobody should be working certain hours.

Everybody has the right to work in a safe workplace and from a physicality perspective, everybody should be able to do the same tasks as each other, regardless of their gender. And while we're talking about that, not all men are super strong, there are some women that are much stronger than some men.

And just because you're a man, should you be lifting really heavy objects because that's physically not good for you or your body in the long term either.

David Cummins: G'day and welcome to the AHDC podcast series, Health Design on the Go. I'm your host, David Cummins, and today we are speaking to David Ross, Registered Architect and a Director at Keppie Design in Scotland.

Keppie Design is Scotland's oldest Architecture Firm in Glasgow. David has been part of several carbon neutral hospitals, including a new hospital in Monklands.

Keppie Design is world renowned for healthcare design with a strong focus on sustainability following the Scottish government sustainability targets to reduce carbon emissions. David is also a very successful author and has written over six books of fiction and is an internationally celebrated author.

We look forward to talking to David as part of our Sustainability Series for Health Design on the Go.

Welcome, David. Thank you for your time.

David Ross: Morning David, it's good to talk to you.

David Cummins: I must admit, I've met a lot of architects in my time, and I've never met an architect who's an author. I have to ask that question first.

How, how did that come about?

David Ross: Well, it came about by Chance.

About 10 years ago, we were working overseas a lot, but not in fantastic places like Australia where you've got lots to do. We were in unusual places like Libya and the third, fourth and fifth tier cities of China.

I found, maybe like a lot of authors, that I had a lot of time in my hands when not working and you're on planes a lot and things like that. It started off really as a bit of therapy to be honest.

I had written some things previously design articles and I guess writing and English was something that I was quite comfortable with.

But I'm doing book festivals now. It is amazing how it's one of the first questions that I get asked, and I find it quite unusual, like people say, "well there's two industries that are completely worlds apart, architecture and writing".

And I've never really seen it like that. I think they're very connected.

For architecture, you're trying to develop design environments for people. So, you're trying to understand people and their needs regardless of where it is in the world, and develop the correct response and environment for them. I'm writing because place is quite an important thing to the writing, the fiction that I write.

You've already got an understanding of environment and you're creating characters that work in a way where the place is actually part of the story and part of the plot. And sometimes, I think, I couldn't really have done one without the other. I don't write dystopian fiction or shit that's set in the future or fantasy or anything like that.

I mean, it's very authentic and real. So, an understanding of the environment and how it affects behaviour, whether it's fictional characters or whether it's real people, is central to everything I do.

David Cummins: Yeah. That's very impressive.

You were talking about a lot of the travel that you've done as an architect, and I know Keppie Design being one of Scotland's largest architect firms does a lot of international work, especially in the work of health design.

I know you guys have been overseas in Asia, the Emirates, China. How important is it for a Scottish architect, or should I say, how important is it for the world to learn from a Scottish architect, knowing how good your designs are on the international scale, especially in reference to sustainability and health?

David Ross: Healthcare expertise is what took us into an international market, primarily. We've worked on other sectors and other functions, but I guess it's the one demonstrable thing that we can export.

Keppie did the very first NHS hospital design in Scotland 70 years ago.

So, we've been part and parcel of the development of healthcare in Scotland from the very beginning of that service being set up.

And going all the way back to the time of Charles Rennie MacKintosh, who was a former principal of the practice. The practice has had an interest in what might be termed social architecture.

I mean, we do other things as well, we've got quite a large commercial output, but fundamentally it's our understanding of how to put healthcare projects together in healthcare guidance for a health service that has taken us into places as diverse as Oman or Saudi Arabia or China or even parts of South America.

And I think the other recognition really is, we are not a massive international practice in terms of some of our competitors, but we punch way above our weight because of an understanding of the healthcare guidance and how to apply that to countries that are perhaps starting to look at how you develop a system that's not healthcare for sale, but an availability at the point of source.

So we've been involved in one client side with countries that are perhaps 20 years behind where the UK has been that are looking at different mechanisms of procurement, whether that's PFI or whether that's private investment or whatever.

We've got all of that experience therefore, we become attractive to government or health ministry departments in those countries first and foremost. Very difficult as you would imagine, very difficult for an organisation the size of Keppie to bid major projects on the other side of the world.

But we've done that as well. We've been involved in successful bidding or practice, won the very first PFI hospitals in Egypt to two relatively small maternity hospitals in Alexandria. And that kick started that whole expansion and development of healthcare in that country.

It's a really broad and diverse portfolio of work. And once we're finished here, obviously you're going to be contacting us at some point in the future and asking us to do something in Australia I'm sure.

David Cummins: That's certainly on the cards and we've got some pretty amazing architects here, but certainly diversity is something we welcome.

I think we've got enough Scottish architects over here already to help with that diversity card. So that's really interesting. I'm not expert in Scottish law by any means, but I understand that the Scottish law or Scottish government has the power to actually set their own admission targets for buildings.

And I assume that includes healthcare as well. So that's quite unique, is it not to the Scottish region?

David Ross: Yeah, your listeners might understand that there's a bit of tension in the UK at the moment about whether Scotland might become an independent country at some point in the future.

There was a referendum in 2014, which was very close and I think following the 2016 referendum that took the UK out of the EU, that was very unpopular in Scotland. Therefore there's been a push from the governing party here, the Scottish National Party, to rerun that referendum on Scottish independence.

And at the moment there's devolved powers for a number of things. Not necessarily things like defense or overall spending on large elements. But for elements of health and education those devolved powers to the Scottish Parliament.

And as an add on to that, the climate change targets and net zero carbon targets that were set by the Scottish government, I think were a bit more ambitious in the initial stages than the UK government were setting.

You're going to ask me what they are, I've reached the age in life now David, where I've got a terrible memory from figures and but we are aiming for net zero. I think almost all of our public expenditure buildings now, healthcare being perhaps the most significant because, obviously healthcare hospital buildings are operating 24-7 and they've got massive energy usage.

I guess the feeling from the industry is if we can crack net zero carbon targets in a realistic and meaningful whole life way on a large acute hospital project, then we should be able to hit that target on any building type. .

Yeah, for sure. And it certainly makes you pioneers in the industry and certainly world renowned.

That's certainly how the Australian Health Design Council first came across your work. I know you guys worked on a project or a hospital in the Northern Islands of Scotland, and I also know you're working on Scotland's carbon neutral hospital as well near Glasgow.

So do you mind just talking to us through some of the principles that you've used on the Northern Island hospital and this new hospital, some of the principles and how you overcame some of the resistance from not only the users, but also some of the design resistance principles that you just had to overcome?

Yeah, the two projects that you're talking about are firstly the new Balfour Hospital in Orkney.

Orkney's a small island off the north coast of Scotland. Very remote and difficult to reach and hard for building contractors to build there.

Obviously there's additional costs on getting materials to the island. But the Orkney Hospital had been part of a long term program that we are going through in Scotland at the moment that is looking at hospitals that are over 40 years old and are outdated.

There's a desire and hopefully we are part of that.

There's now a desire to try and develop a national vision for healthcare. There's 14 regions of NHS regions in Scotland so unlike England, when I think there's maybe about 60, that 14 is a manageable target to be able to set consistent standards for healthcare going forward for the next 20, 25 years.

And I guess to some extent for us was really the starting point for that process. It was very different from a mainland hospital because the weather and the climate and the accessibility to services like gas anyway, is completely different.

So right from the outset, the design had to respond to these different climatic conditions. I think it's fair to say that if the hospital is talking about being the first in Scotland to be net zero carbon from an operational point of view, but that wasn't the brief at the very beginning.

The brief was fairly standard BM targets at that point and I think the unavailability of gas on the island was one of the main things that perhaps allowed a different type of conversation about energy use to take place.

Monklands as, as a contrast though, Monklands is the biggest hospital project, one of the biggest in the UK at the moment actually, nevermind Scotland and it's because of the devolved government targets that we talked about earlier on, it's had net zero carbon as an ambition right from the very beginning, built right into the brief.

So in that case rather than just the understanding of a whole operational philosophy with the Belfour producing a carbon neutral outcome, Monklands has net zero carbon as an aspiration and ambition from the very beginning.

Now, that's a challenging thing for the government and everybody else involved in the project because, net zero carbon is an ambition for a major acute Hospital in the mainland and has additional and quite substantial on costs for capital expenditure at the very beginning.

And I think what the industry's perhaps struggling with are wee bit at the moment is how to properly benchmark that, so what we found in the design of this hospital, and at the moment we are at the moment of recording this podcast, we are just about to go into our IBA stage three, technical design.

Albeit, it's a far more advanced and developed IBA stage two design than would normally be the case because of procurement approach is different. But what we found as traditional standard healthcare floor to floor heights, for example are all having to go up substantially now.

Because to hit an eight zero carbon ambition for an acute hospital, the amount of plant and service coordination is enormous. And therefore that's a significant on cost to the building that wouldn't necessarily have been planned into the original cost plan, expenditure, benchmarking.

So, for a whole host of reasons, Monklands is an exemplar design in every sense of the word, and I think we'll set benchmarks for healthcare in Scotland.

The reason I was talking there about the ability to try and create a national vision for healthcare going forward. It's not just a wooly aspiration that everybody wants to hit. It's the ability to use a major catalytic project like Monklands as the mechanism to be able to do that.

To set standards that are actually changing how projects are benchmarked from a financial perspective at the very beginning. It's quite a controversial thing for me to say I suppose, from the private sector, architectural side, but after 30 years of working in healthcare in Scotland in the public sector, I always kinda felt that inadvertently the projects were being set up to fail, and where they fail as normally the financial benchmarking of a hospital and the quality aspirations don't align really, so the desire is to try and get the capital cost target down as low as possible.

So, what we really should be focusing on as a whole life cost thing rather than just that small percentage of initial capital cost and then work towards what the building actually contributes over its whole life.

And can its whole life be more than 40 years? Well, it should be more than 40 years. So there's another thread to this, obviously, as in terms of how adaptable you can make the design. And previously we didn't really get the chance to investigate that in enough detail because the procurement route kind of stopped it.

And when we talked about, I don't know what it's like in Australia, but generally speaking in publicly funded projects, previously when innovation was discussed, it was loosely branded as "design innovation" or potentially innovation and how the building operates. But what that was effectively code for as "how cheap can you build it"?.

Because you're putting it out to tender with maybe three, four contracting-lead teams of their own consultants who are then interpreting a loose exemplar design. So they're coming back to the client and saying, "here's what you're going to get".

Monklands is a different procurement route and is effectively developing the full detail of the entire design and its operation including all the embodied carbon targets that are in the materials.

It's developing that to stage four design, and then it's going out to a contractor. And a contractor in my mind then does what they're good at. They investigate ways in which it can be built more efficiently or it can be built better. They're not being asked to reinterpret the design or fill in the loose gaps of the brief a wee bit more economically.

So it's a really refreshing way of looking at how healthcare would be developed, but also not looking at maybe Monklands as a project in complete isolation. Looking at what its legacy might be for other major projects around the country.

David Cummins: Yeah.

Yeah. That's fantastic because, I've done my PhD studies, my plan on the resistance to reducing the carbon footprint in Australian healthcare design. And one of the biggest barriers that we have for many reasons is money, cost too much, cost too much, which is pretty much the way it would've been in the UK 20 plus years ago.

How important is it to have the decision makers and the government and the people with money, put their support behind such a project as opposed to give resistance for why not to do it because they don't have the money. How important is that to have the money and to have the sustainability as one of the number one KPIs for a project, at that early stage, as you talked about?

David Ross: Well, it's very important to have support for the initiative, and I'm not often fair to politicians, but to be fair to politicians at the moment, when financial costs start increasing, particularly in an environment like we have politically at the moment, and this isn't unique to Scotland.

There are binary attitudes to political decisions all over the world. I don't think necessarily social media assists in that, it just makes everything worse. And therefore, if there's a perception of failing in public investment in healthcare, then it's a political target as opposed to an attempt to try and understand how can we do this better.

So yes, you're absolutely right. Having the fortitude and having the determination from a government point of view, to make sure that expenditure is appropriate and understanding that if you're going to hit a net zero target or you're going to try and do something different for the benefit of everyone in the future, then there's going to be a bit more capital investment for that. Because you have to pay more for it up front, but it'll pay longer.

And I think there's an understanding of this now. Where I think we need to go with it, and I'm probably repeating this a wee bit... Rather than see that individual project, as a result of its net zero carbon ambition is now 20% more expensive than it might have been otherwise...

we need to get that knowledge into the next project so that you're gradually reducing the expenditure of every project that follows it because it's following a similar path.

It's a really clever industry, but by God can it waste money! And it's determination to try and reinvent the wheel every time.

It's unbelievable! What we are trying to argue for is, "let's raise the benchmark and raise the standard of public sector work". But having done that, a whole series of design components and design uses and design philosophies that can be reused.

David Cummins: Yeah.

David Ross: I'm a simple person, David, I can't understand why you wouldn't want to try and take that as a visionary thing. Why waste money every time you approach the next project? It doesn't make any sense to me.

David Cummins: Yeah, I think that's very well said.

We are running out of time David, but I just wanted to say thank you so much for your time and thank you so much to Keppie Architects. You are world renowned leaders in this space.

You are world renowned leaders in sustainability. People in Australia have been talking about you for quite a while now, and I'm just so grateful and so impressed by your conversation. I would like to have more time with you, but we have gone out of time, so I think we might have to do another podcast in the near future.

David Ross: That'd be good!

David Cummins: Yeah. Very, very, very impressed and very, very grateful for your time. And good luck for your book as well, I've already ordered it on Amazon.

David Ross: Thank you. Thank you.

David Cummins: You have been listening to the Australian Health Design Council Podcast series, Health Design on the Go. If you would like to learn more about the AHDC, please connect with us on our website or LinkedIn.

Thank you for listening.

David Cummins: G'day and welcome to the AHDC podcast series Health Design on the Go.

I'm your host David Cummins, and today we are speaking to Stuart Turk, who is a qualified Critical Care Nurse.

Stuart has been involved in clinical planning, nursing and medical education, program development and delivery across Australia for over 25 years. As a Clinical Health Planner, Stuart is heavily involved with design, development, and delivery of health environments.

Stuart is currently speaking around the world on his health and design experiences and how to improve Human-Centred design, which is why he's perfect today to speak about our Human-Centred Design podcast.

Welcome, Stuart. Thank you for your time.

Stuart Turk: Thanks for inviting me, David. Happy to be here.

David Cummins: First question, what is Human-Centred Design?

Stuart Turk: So, what we've done for quite a long time and when I first started being interested in design, we looked at patient-centred design and models of care developed around patient-centred care.

And what we did was we said, okay, we need to do these things, but to improve the patient experience, to make sure that we're more reactive to ensure that patients got the best care at the right place at the right time.

But we seem to have forgotten about the people who work in the building., we haven't thought about the nurses or the doctors that spend their time in the building or the people who provide the ancillary services, the cleaners the environmental services people- porters, people like that.

It was highlighted during the pandemic, one of the big things that happened was the spread of Covid in actual hospitals wasn't so much from patient to patient.

And I think Health Infrastructure in New South Wales presented a fantastic series on the way they found the spread of infection in hospitals was when staff went into staff rooms and removed their masks to eat their meals and then chatted amongst each other.

The result of that, which really... (I've got a lot of friends who are still nursing), these people were forced to go and eat their meals in their cars or go to places outside of the hospital so that we could reduce that spread of infection.

But what I really highlighted was the lack of spaces or amenity for those people to go to. And for me I recently presented at the SALUS International Congress for Healthy Cities, Healthy Living, and one of the things I was focusing on was, the other thing we forget about is that it's a stressful environment.

We know that the burnout rate is increasing. The other thing that we know from population data, and I think I know this is not being put out today, but United Nations released information during the week, and what it highlighted was that the population of the world, the amount of children is decreasing, the amount of aged people is increasing.

So, we've moved to this point where we've got so many people in the world but, because of the aging population, we're running out of people to do the jobs, and that's going to carry on for a few more years. And what we started looking at in our practice and that I started discussing with Mrs Thomas quite a lot was how do we help hospitals? How do we help facilities? How do we help health organisations retain people and attract people? And we kept coming back to this... Hospitals aren't just for patients. The hospitals are these places where people spend a lot of their time working.

So, I guess for me, Human-Centred design came from what happened with the pandemic, but also with the aging population and the impact that's going to have on the workforce. As a nurse myself, David, I've been with Silver Thomas Hanley for, this will be my third year now, but up until then I was working as a nurse and being a senior nurse, I was able to work for agencies.

And I didn't want to actually work in any one particular hospital, but I certainly had two or three hospitals that I loved working at. And the reason I loved working there was because the amenity was better. The access to an outdoor space or the access to a larger tearoom or the access to a breakout area really significantly influenced whether I went back to a facility or not.

So, bringing that experience in and then trying to write about it, it's really difficult, because everyone wants to give everything to the patient.

Patients got to have the biggest room, got to have the best ensuite, got to have this, got to have that. But the people delivering the care, they need a bit of love too, I guess.

And, and that's where I'm coming from.

David Cummins: You're a hundred percent right.

We've all been on the design and the construction tables where you do give that more space directly to the patient, inevitably to help the staff as well, because you want more space and more working space.

But I've also been on, in the director's chair where, the staff rooms are so small and there's no natural light and there's one fridge and you double up the staff room with the medium room because you hit the requirements and that need for outdoor space and natural ventilation,

the research shows that how much it improves the patient care, but there's very little research to show how it improves, resources and staffing and everyone.

So, what you're saying is a hundred percent correct, it's just I don't think many people have put the two and two together recently.

Stuart Turk: No, I agree, and I think one of the things when we go through planning, you've been through planning, and one of the things I notice is when it starts to get short on space, they're the spaces that get attacked first because everyone wants more storage, that comes up quite regular, "oh, I need more storage. We've got all this equipment".

And it's like, "okay, well, we'll just chop a bit off this staff room, and we'll chop a bit off this breakout space or this meeting room".

And exactly as you said, you get to a point where people will go, "oh, we'll put a petition wall, an operable wall and we'll have that and that can be between the meeting room and the staff room", and it just gets left open.

It never becomes a meeting room; it just becomes that bigger staff room and I don't have an issue with that.

Don't put the operable wall in. Just say it's a big staff room, it's okay. Like, look after the people.

David Cummins: So how does one argue budget versus Human-Centred design? Obviously, patients bring in money, staff use money.

You can't have one without the other, but it is way easier to argue a bigger space for a patient who needs three or four nurses for a transfer versus a bigger space for nurses needing a meeting room.

I think your ideas, your principal in research is fantastic, but at the end of the day comes down to money so how, how does one argue that?

Stuart Turk: Well, you could argue about money, you could say "oh you know, the cost benefit", and so the first thing is how much does it cost to onboard someone?

And if they hate the experience and they quit and they're gone within a month, how much did you just burn? So, there's one way you can argue money. I think the other thing is that it's not so much about the money side of it, David, the thing with that population change and with burnout, we're running out of people.

It's something I keep saying and, and people really struggle with the concept. You can't open that bed for that patient if you don't have a staff member. And I think that we're starting to see it now, but I actually think that's going to become a bigger problem.

Because five years from now at around 2030 we hit the absolute peak of this age change.

So, we hit this peak where people are all retiring, we never trained enough people to come through and replace them, the people that we are retiring are going to need their joint replacements or some of them might have led sedentary lifestyle, so they're going to need the gallbladders out.

So, all these people are going to need care, but we don't have the people to care for them. So, I think organisations have to think differently about investment. Capital investment isn't just about how much money I can make, you're dead right, it's about the quality of the service that I can deliver, but also that attracting and retaining staff because my experience is...

I made more money as a casual, I could make a lot more money working as a casual nurse and picking and choosing than actually being a permanent staff member in a hospital.

People always want that job security, right? I think for me, that's one thing... there's a certain group of people they want their job security and they're happy with where they work, but it's not enough people to sustain a whole organisation.

One of the things I worry about is we're building these massive hospitals, we talked about this at our meeting with the Australian Health Facility Design Council, where we're saying, you we're going to build all these hospitals, but we're not going to have anyone to staff them.

David Cummins: Yeah, I hundred percent agree.

I feel that these ridiculously big budgets all coming out at the moment for certain facilities, and they sound good and they look good, but as some key people around us three have said "we don't even have enough staff now to support our patients". So, what are we going to do when there are certain hospitals around Australia at the moment that are literally opened in a 25, 30% capacity and brand new theatres are not being opened and operated because they do not have the staff.

And part of that reason is because they don't actually have the staff to maintain. But also, staff are going elsewhere where they can have outdoor facilities, they can enjoy the fact of where they're living or working most of their lives.

So, you're a hundred percent right.

What do we need to do as designers, as thinkers, as builders, as health professionals?

What do we need to do to try and, prioritise this more?

Stuart Turk: Well, I think one of the things for me is, and I think you know yourself; we can go into a meeting and we can say, oh "this is a concern", but it's organisations have to own this. Organisations themselves, if someone's considering a strategy to build a new hospital, they have to build in what they need for staff at day one, and they have to stick to that vision.

You and I can sit in a meeting, and we can bang on the table and we can say "you've got to look after your staff, you've got to look after your staff" but at the end of the day, you know exactly as you said, well, how am I going to get another theatre? How am I going to get 'x' more beds?

This is actually my brief from could be the government, it could be from a private resource. This is what I've got to deliver.

They need to be more strategic about how their workforce. How they have their workforce, how they treat their workforce, how they grow their workforce. Because without them, they can't do anything, and I'll continue to sit in meetings.

We interview for a lot of jobs that we do. So, we will go through a process a tender process, and then we'll have an interview. And one of the things I talk about, and it's passionately because, being at the frontline as you have, in your previous roles, you've got to look after these people.

Now, if you don't look after these people, they will not look after you.

I remember a long, long time ago I worked for an organisation who said, " our greatest asset is our staff".

And I think that needs to come back. That sort of thought needs to come back because once it comes back, those things you are talking about, the outdoor spaces, the access to air and light, that's where it comes through in the strategy and that's where the design is.

For me, one of the things I find interesting, and I love about my job is I get to work with some really creative people.

I can describe something, so a lot of my work is briefing and I'll say, "we need a tea room, the tea room needs to be able to hold X amount of people and it needs to provide this facility".

But then, as you're writing that briefing... " No, I want natural light. I want access to natural air. I want people to be able to go outside. I want them to be actually able to choose their space".

So, when we design the space, instead of just doing a big open room with half a dozen tables, you can have some booths, you can have some tables, you can have some benches and people can choose their social experience for their mealtime.

It might be that you've had a really bad morning and you just want to go and sit in one of those booths and you want everyone to leave you alone. You might be having a great day and you want to sit down with everyone and have a big chat.

Or you might just want to sit there with a couple of friends that you're working closely with or colleagues and discuss, " oh geez, what are we going to do this afternoon"? But actually giving people that choice.

David Cummins: Yeah, we've actually doing a podcast series on landscape architecture and the importance of open spaces for patients and staff as well.

And the people we've been speaking to have reported very minimal research in that space, even though everyone understands it consciously when we experience as a staff member and as a patient, what is the research in this field like?

Is there much research or is it very much just experience, given experience given your background at the moment?

Stuart Turk: I think one of the things I've found really interesting is not a lot of places do post-occupancy evaluation. And I guess a lot of that comes down to how long it takes. So you know yourself, like whether it's a government or a private project. You're looking at probably a three year, four year process from start to finish.

So one of the things I'm really keen to do is start doing post-occupancy evaluations on my projects. Now the problem I've got is my very first project is still two years away of being completed, but it would be good to go back in there and then do that survey experience "how do you find this environment?".

We could do research on this. We could actually use agencies. "Which hospitals are your popular hospitals and why?". And then go through that sort of process.

I think you're right. I don't think there is a lot on this. I think it's evolving and I really think the pandemic pressed it.

So I know I talk about the population and population data, and I know it does people's heads in, I get it. But we knew that we were going to have a problem. We knew that we were going to have a problem with staffing.

In 2000 I saw someone speak from the Australian Bureau of Statistics at a Rural Nurses conference, and they're saying the problems that are going to be faced not so much by the larger regional, but the smaller regional and rural communities because of the lack of people being trained and the aging population.

So he went through this whole thing and I walked away from it and I just thought to myself, If we're not doing anything now, if we're not increasing our nursing numbers now, if we're not increasing our allied health numbers now, if we're not increasing our medical numbers, now how are we going to battle this?

And they kind of government after government, we had changes and it doesn't matter who it is. We've had multiple governments of either parties and they didn't really do much about it. What Covid did was accelerate it, and at a great rate. So people I know that were nursing, that were a bit older and were probably thinking of retiring five years from now, they all retired.

And what actually happened was a whole bunch of experience and a whole bunch of knowledge walked out the door. Now the things that we're starting to see come in the RUSON, these are undergraduate nurses in their second year, they can go in and opens the old debate, hospital versus university.

I think a tertiary qualification is essential.

But how you gain that skill or that experience, that's actually not fixed. We can muck around with that a little bit.

So what they've done with this program is introduce second year nurses who now come in and they work in hospitals and they have their rosters and they get paid to do that work rather than flip burgers at McDonalds for two years.

So we've got that program happening and I think that's phenomenal. It's brilliant because we still have the university tertiary component. You still have to do the theory, you still have to do the study, but being able to put it to practice. You're doing it before you actually finish your degree, which is awesome.

And you're learning on the job from skilled people. And then we've got governments now coming out saying, "we're going to wave your HECS" ( A Government university loan scheme in Australia).

Which is fantastic, but we are waiting another three years for those people to come through. They're not instant. So, hospital design looking after people moving to more digital solutions as well, will help combat all of these things.

But we need to stay patient-centred, of course we do, but we also need to be staff centred and we really need to focus on that and do it better and that will keep people in jobs. It'll keep people in the hospital, keep your beds open, keep your operating theatres moving.

David Cummins: Yeah, I worked in a hospital once where it had this beautiful outdoor space that the staff loved it, the patients loved it.

It was such a busy, popular space and then the new redevelopment was announced and they said, we'll, take that beautiful parkland space right there.

Stuart Turk: Yeah.

David Cummins: So, and Definitely the mood changed at lunchtime after it was complete because why is this beautiful outdoor space? We could only sit indoors.

And I remember going to the cafeteria after it was finished which was in the basement now there was very few people in it.

Because everyone wanted to be outside, but there was very few areas to be in, so staff had to walk further and, No doubt it impacted some form of patient safety because the staff that were initially, only a few meters away were now across the road or at a different park or something like that.

And that sense of community and that sense of culture was dispersed and it was a very visual representation of a lot of staff versus a lot of staff, you know, basement versus outdoor.

So I think you are a hundred percent right.

Stuart Turk: I think one of the things like, you know, I worked predominantly in emergency departments and as we know, you know, you don't have big windows in there because you don't want people seeing me in, and you tend to use a lot of borrowed light as opposed to a lot of actual natural light.

And the reason the outdoor spaces are really important to me is because 24 hours in, you know, and okay, you don't do 24 hour shift, but say you do a 10 hour shift in the middle of winter in Melbourne, you start in the dark, you're finish in the dark, and you spend all your day in artificial light.

So it's actually not good for your mental. And it's not good for your physical health and these are the things that drive me.

You need somewhere to go. You need that space and you're right, they should have protected that space, shouldn't they? It would be good to do a survey of those people pre and post survey and see how their mood and how they felt towards the organisation they worked for and if that changed. If there was a shift.

David Cummins: Yeah, it's very interesting.

Finally, before we go, is there any take home message that you'd like to give to our listeners, architects clinicians and builders that like in reference to Human-Centred design? \

Stuart Turk: Yeah, just, you know imagine empathy is one of my favourite words at the moment.

Put yourself in the shoes of the person going through the experience. How would you like it to be for you?

Do you want to be stuck in a basement 24 hours a day, seven days a week? Would you like that? So I think probably, you know, if we could all be a little bit more empathetic, and I know it's become a buzzword, I appreciate that, but it's so true you know.

Think about how other people move through a building and what their day involves and how we can make that better. Because if we don't look after the staff, they won't look after the patients.

David Cummins: Yeah, I think that's very true. Stuart, I just want to say thank you for your time.

People like you, the clinician that's become a designer, with the clinical health background, you're a powerful being and your research and your projects can certainly see that.

I've certainly seen some of SDS projects and worked on them, and they're all fantastic.

It's forward thinkers like you and STH that really help patients and staff and Human-Centred design move forward so thank you very much.

Stuart Turk: Ah, thank you, David, been pleasure.

David Cummins: You have been listening to the Australian Health Design Council podcast series, Health Design on the Go. If you would like to learn more about the AHDC, please connect with us on our LinkedIn or website.

Thank you for listening.

​David Cummins: G'day and welcome to the AHDC podcast series, Health Design on the Go.

I'm your host David Cummins, and today we are speaking to Matthew Manos, who is the founder of Very Nice, which has been operating for almost 15 years. 

Very Nice is a design strategy practice that specialises in brand strategy, experience design, and strategic foresight. Matthew is an Assistant Professor of Design Strategy at the University of Southern California.

Matthew is very interested in the world of design thinking, and recently been focusing more on the world of and health care, and innovation. Which is why he's the perfect guest today to discuss the art of consulting in health design. Welcome, Matthew. Thank you for your time. 

Matthew Manos: Thanks so much for having me David.

Happy to be here. 

David Cummins: For those that don't know more about your practice Very Nice. Can you just explain to a few people what Very Nice is and what you exactly do? 

Matthew Manos: Yeah, absolutely. So  is a design strategy consultancy and what that really means, and when we think about design strategy.. We're really referring to the art of figuring out what needs to even be designed. 

That's the way that we think about it. So this can include a lot of listening, which we'll talk about today, research with users, thinking about the market and what are the openings for various brands to position themselves and create unique value. 

But I think what's really interesting about  is, since day one, we've had this model and this commitment to give half of our work away for free to non-profit organisations. 

And so to do that we have built quite an army of volunteers that support us and that work on various projects for smaller grassroots organisations as well. And in addition to that, we work with a lot of larger organisations like the American Heart Association, Google, the United Nations, Apple, all kinds of folks on all kinds of really interesting projects as well.

One thing that I would that I bring, and that brings very much as its ethos into any of this work, is a sense of creativity and innovation. A lot of that stemming from the fact that we started as a graphic design practice actually. So we did not start as a strategy firm at all.

And pivoted towards that about four years in to the business. So still fairly early in we made that move. But I think that those creative roots really influenced the way that we do our work and the way that we collaborate with our clients as well. 

David Cummins: Yeah. Design thinking is very interesting and it's something that Australia's really only discovered certainly the last maybe five-10 years, and you were way ahead of the curve 15 years ago with design thinking.

For those of you that don't know what design thinking is, can you just explain it a little bit more simply for, for people to understand exactly the power of design thinking when it comes to a problem. 

Matthew Manos: Yeah, absolutely. The way that I like to describe it is it is about building a bridge between the needs of people and the needs of business.

And the way that this is really revolutionary is traditional consulting would take a side, it would take the side of business and it would say, this is the exact bottom line strategy, this is where we need to head with this product in the future, this is my idea, whatever that might be. And then they would put it out there and say, Hey users... hope you like it.

And that did not lead to very inclusive innovations, innovations that are representative of people's actual needs. And I think that that is the real power of a design driven approach. Aside from that sort of ethos wise, methodology wise, it's often referred to as this process that is divergent and then convergent.

So divergent being, Hey, let's start by thinking about all kinds of ideas, there's no constraints. We can come up with anything. And then convergent being, all right, we've done that. Now let's filter based on the goals of the project. And I think that really lends itself to that creative space for ideation that just drives ideas that you don't normally see.

David Cummins: Yeah, I totally agree. And for me, one of the best things of design thinking is we were always taught 90% planning, 10% execution. And everyone still today goes into a solution mode when you still don't understand the problem. So I think what design thinking does is it takes you through every process to understand what the problem is and if you really compare what you thought was the solution initially to what is the actual solution, it's very, very different.

So I do think that benefit of that process is extremely powerful. 

Matthew Manos: Yeah, it really challenges bias I think, I think what you're saying speaks to that really well. And that that just is fundamentally different than the way we've thought about innovation for centuries. It's always been, oh, some genius comes up with an idea and invents it, and it's sort of in this bubble.

And they just were born with this gift to be able to come up with this idea. 

And I think what I love about design is it's all about people and it's all about involving people in that process. And eventually, businesses have really woken up to the fact that that's not just a nice thing to do. It's something that actually is taking your customers along. 

They're the ones that are going to be purchasing these products using these services. Why wouldn't you want to do that right? To me that is especially important in healthcare, which I know is a space that you're working in, that is such a people oriented space as well.

David Cummins: Yeah, I think we've all been in rooms where you find someone of authority and they go straight into solution mode and everyone agrees to it without any thinking. 

And then not all the time is it a positive outcome. But I would say with design thinking process, you're pretty much on the money most of the time, which I think just gives you that little bit of extra time to understand the problem, to get a better result in the end.

So in reference to design thinking, I would say as well with the research I've read of yours, there's actually a lot of leadership principles there, such as empathy, listening, understanding removing ego collaboration. 

So I find your research quite interesting in the sense that you've actually used design thinking principles and leadership principles and put them together for the benefit of healthcare.

Do you mind just talking a bit more about your leadership principles in reference to consulting? 

Matthew Manos: Yeah, of course. I think that the leadership principles with consulting are actually quite aligned just with the design principles that I have, which is how can you create space for a team to thrive, be themself, which means be a bit strange, be a bit peculiar, right, that divergent phase. 

But then how can you also be a leader that makes it very clear? What are the steps? What are the action items? What are the deliverables? And that's very much that convergent phase.

I think in a lot of our work with our clients, and luckily this has not been too hard to enforce because we work with a lot of, really great clients that are in the non-profit space because they care about people and their constituents and stakeholders. 

But we've really tried to instil this idea of listening, and more often than not, it's less about convincing an organisation to listen. It's about convincing them to listen to more people.

And so how can we take major decisions around the direction of a program or initiative or of a product outside of that boardroom and actually into the streets and into a space where you can hear from the everyday people that are listening to as well. 

David Cummins: Yeah. And so that feeds into as well the community involvement and consumer understanding because at the end of the day when you've got people in an ivory tower saying this is the way to do it without actually listening to the masses, especially in healthcare, I find it quite interesting when people actually haven't asked the consumers of healthcare exactly what their needs are.

Matthew Manos: Oh, absolutely. I had a friend of mine that owned a creative agency in New York, and they had a client that was a toy company. They were coming out with a new toy and it was geared towards young boys, age eight to 11. 

And the, the friend of mine presented the work and the founder of that toy company said, you know, I don't like I just don't react well to red.

Right? Something like that. 

And my friend, I thought this was genius and brave said, "well, sir, you're not an eight year old boy"... 

And this is such a good example of the way that so many, especially design decisions and, when I say that in this case, I do mean visual design, it tends to really be an afterthought in terms of what will actually be most effective or most useful, or most inspiring for that person.

And when it comes to healthcare, and I know just a lot of technology fields as well, that can very much look like creating standards that are used across the board, and those standards are ultimately modelled after a sample of people and is sort of inkling or an interest.

Those people might not be representative of the folks that are actually using these innovations as well.

David Cummins: Yeah, I 100% agree, especially in the world of health design where you're actually designing a building and where you actually have sometimes minimal consultation with the patients or the visitors. It's generally a nurse that's been there for 30 years, but has no reference point in any other hospitals.

So it's opposed to one person's opinion versus what is actually best practice for the greater good of the patient. So that is a common theme that I've seen throughout my career where at longstanding hospitals with longstanding staff they choose what they want, not necessarily what the research says.

So I do find that interesting knowing that that person will one day go. 

Matthew Manos: Absolutely. There was a great project that IDEO did, (which is a really great design firm) I think operating globally as well. 

Where they were approached by a hospital to sort of create a new design, a new healthcare design, space design in particular that would calm patients especially patients of a certain category of experience that they were having health wise in the hospital. 

And apparently all of the suggestions from the client was can we maybe put up some plants or get a new mural, or whatever that might be. 

And what IDEO decided to do, and this was many years ago but I still use this as a reference, is they actually strapped a camera to their head and they say, "Hey I'm going to live as that particular patient for the day".

And the footage comes back and 90% of it is of the ceiling. And they're lying down on a bed. And what is the plant in the corner of the room going to do at that point right? And so I think that these are really good examples of where you have this good intention, these great ideas.

Maybe it's things you've seen before, but you're not seeing it through the correct eyes. And I think nowadays in design it's actually evolved even more where it's saying how can we actually hire people who have these lived experiences similar to those who we are designing for and actually have them be the designer as well.

So all of those things are really exciting to me in terms of the ways that the design strategy consulting field has really grown up over the last almost 15 years that I've been in it. 

David Cummins: Yeah, that's a really good example. The ceiling example is a very good one.

I remember on one project I was on, the design team had put clouds in the paediatric ward and so the kids could look at clouds. But long story short, they all thought they were in heaven cause they were doped up. 

Matthew Manos: Oh, yeah, yeah. See, so that can be problematic too. 

David Cummins: They all thought they died, so they started crying.

Matthew Manos: Wow 

David Cummins: They had to change the clouds with Mickey Mouse and things like that, because they honestly thought they had died. 

So, 

Matthew Manos: wow. 

David Cummins: It's a very interesting concept to have an adult design Peds, without discussions with the actual end users.

Matthew Manos: Absolutely. 

David Cummins: Yeah. So I think that's a really good example. 

Matthew Manos: A project I'd love to talk about, because there's a few projects that I've worked on that really circle this question of listening, let's just call it co-design. Being able to design with the communities that you're actually working within.

There was one project that we worked on with a non-profit here in Los Angeles called Pando Populus. And they were partnered with a number of different organisations, youth organisations in South Los Angeles which was an area that was hit really hard during the LA riots. It's an area that is known for a certain crime rate, et cetera. 

But , I think that the most important thing is that there is a serious amount of vacant lots in this certain neighbourhood that they were interested in working in. And some of those local organisations wanted to be able to come together and improve those lots, actually put something there, activate those spaces.

And so we were brought on to facilitate a workshop that involved community members, church members, members of different organisations in the process of imagining what could this space be? And so what that workshop looked like is actually people literally building models using Legos, using Play-Doh. This did not have to look fancy.

Just something that could actually help them communicate what they wanted to see in their own neighbourhood because these non-profits were based there. 

But not everybody involved in the decisions of what happens in these spaces will be local. You might have a developer come in and put up a giant apartment that nobody wants or whatever it might be.

And so I think that was a really good example for me, seeing the power of a more design oriented approach to even starting the process. And then watching how it can evolve from there informed by that community. 

Some of that work also very much influenced by what we've done with the American Heart Association in building out a toolkit called Exponential Listening.

And this is a toolkit that follows four different steps of question, listen, reflect and learn. And this toolkit was built because the organisation was interested in finding ways to better understand the needs of rural communities here in the United States. 

It's a national organisation, but it operates in sort of a regional manner.

 They're very good at having regional relevance, but rural communities have remained a challenge to really know what are the needs how can we best support that space? 

So again, with that work, we did a workshop with the community where we actually tried out a bunch of different methodologies and saw what was sticking and turned that into a toolkit that then they were able to use across the country as well.

So those types of processes, you don't see enough of that in healthcare. And I say that because healthcare is all about supporting people, right? And yet again, the people are typically the last stop on where the ideas are coming from and really truly listening to those needs.

David Cummins: Yeah, I always say build for the patient. Always imagine that that patient is your mother. And so if you are recruiting the builders and the design team and the consulting team to all remember that at one point, that's your mother in that room, I find that's the unique selling point of healthcare versus commercial or industrial or aviation.

So I always find that really important because people are at their most vulnerable. So you really have to keep that in mind that, at one point in time, a loved one of yours will be in that room. So you have to really make sure, and for me, that's the driving passion and the, and the best part of our healthcare design and, and building.

One of the biggest problems in Australia, I assume over in America as well, is a lot of our projects, we're rolling out about $30 billion worth of work in the east coast of Australia alone in the next few years. But it's generally a government promise, it's a state-based government promise that every state parliament government will be there for four years.

So there's always this time criticality of we have to do it now, we have to win the next election. So they pretty much rush, rush, rush. And as I said before, it's 90% planning, 10% execution. How do we find that balance? When you've got time. Everyone wants it done now and yet. We've got limited time. 

Matthew Manos: I get that question a lot because if you think about what a design strategist does. 

They're sort of professionals at making things take longer right? Because the alternative is let's just put a meeting on the calendar, decide what to do, and do it right. 

And the disturbing thing though is while that saves time, that can create a whole lot of problems. So what happens when you don't design with the user, you might spend a bunch of money on something that nobody wants. 

It might be a very prescriptive solution. Isn't inclusive, could be offensive. When you design with the user, I think that there's a lot of really obvious benefits. There's buy-in, the process tends to be more documented, so it's very transparent as you go as well.

But this question of duration still comes up a lot. And I think the thing that I would say to that is, is two things. One is silly, and I guess the other is serious. The silly thing is start sooner.

I can't tell you how many projects are started and have such a fast turnaround time simply because there wasn't this ability to just start the work.

There was all these conversations, all these meetings about the meetings, about the meetings, about starting the work, and all of that time could have been invested in just... go out there and talk to people. Right. 

 So that's a little bit silly, but I think good advice 90% of the time ..Start earlier, right. 

I think the other advice that I would have is, this doesn't have to take a long time actually. Set it, spending a week going into a community, having as many conversations as possible is something that you could do if that's all you have.

 This is a model that's scalable in terms of listening, in terms of co-designing, and sure it could go on for months and it could have iterations and you could interview a 100 people and you could do all of these things, but you also could just do a little bit and that little bit goes a long way.

David Cummins: I 100%ent agree with everything you've just said at the end of the day, I think that also leads into the importance of expertise in your field and actually having the ability to communicate. 

So what skills and tips do you have for leaders or chairs of a certain user group or a certain practice or a certain meeting to actually enhance their listening skills, noting that that's the importance of, of the question? 

Matthew Manos: It's a good question and it's a big question because it's almost more of a behaviour or mindset change in my mind. We've thought about that innovator as that soul innovator, that person that comes up with this idea.

We live in this society where it's highly competitive. It's very much a get out of my way world, especially in the US and I'm sure this happens in Australia as well, where the default of success isn't necessarily that person was super collaborative right.

That's not necessarily the default. I think that that's changing but it's not the default of what the view of business success is. So in some way the answer to your question is we need to see a mindset shift, almost a movement where it's less about the individual role and it's more about that collaborative role, especially in these design environments.

 I think it honestly just starts there. 

David Cummins: I feel as well, sometimes I've been in meetings where everyone feels they have to talk because everyone feels they have an opinion, which is great, but, then you have the chair overriding things because they feel that they are the authority.

But I certainly, since my leadership training, really choose to listen a lot more and take a step back. 

Just because I'm not talking doesn't mean I'm not listening. 

And just because I'm not talking doesn't mean I'm not thinking. 

And I personally have changed my tact a lot and I feel that, two ears, one mouth. That's the sort of the way it is. I'm taking in double the information when I'm just as opposed to speaking. 

So I do find listening and relaxing and removing the ego and being more empathetic to those that I'm trying to help solve the problem is a way better form of communication than just go into solution mode.

And that's really hard to do because I think a lot of the times, and it's funny because we're, we're doing an interview right now, so I have to admit, I am doing this right now. You are asking a question or you are talking, and halfway into it I'm thinking, what am I going to say next? Right? That's what happens in these meetings. 

I think it is because the professional world is highly performative and it's very much around how will I show up, what will I say.. 

To the point where people aren't truly listening versus if you're that quiet one in the room. And I actually tend to be that as well. 

When I'm in a larger meeting, I tend to say something towards the end of the meeting. And for me, that's my way of trying to be a sponge for everything that's being said and trying to be a dot connector too, and a synthesiser.

And , this gets me to another point or a bit of advice both on design leadership, but also design work in general that I try to instil in my students or in any designers that I'm mentoring is. 

A lot of times we see the designer as the creator of something, but I think we should shift to the designer as the facilitator of the creation.

And that to me is a much more powerful role. Not, powerful is not even the right word. Just a, more honest role of, of what we can do.

we're thrown into professionally, environments where we have to design for something that frankly doesn't affect us at all, right? Like we're often designing for others. That's by definition the field. 

So what we want, or us as the creator, can't matter, less and yet we have the tools and the process and the method and the mindset and we can bring people along through that and actually lean more on maybe the client or the community or whoever it is that's actually in affected. I think that can make us really strong design leaders.

 I 100% agree. What I have found in my career though, there are certain architects that do listen a lot more and there are certain architects that don't listen and try to push their own agenda.

Those architects that listen a lot more seem to have better clinical outcomes in the long term versus those that try to push their own agenda because that's the way it's always been done. So I do find there is a certain decorum and a certain respect that those listening architects have that is a skill that not everyone does have, which I think a lot of architects and even any form of leadership or chair should aspire.

Yeah, and , I think again, it comes back to a mindset shift where I would guess the architects that go into this with their own agenda and they try to push that. They really value the output. They really value what is going to show up in my portfolio, what is this going to look like at the end?

And then the ones that value the listening, right, they really value the process and that is actually what defines them as a creative architect. Not necessarily the work that they do. That's the designer that I've become where I'm not in love with any end solution at all. 

I am in love with the process and the methodology. And I do think that that shift, it's not a shift that everyone has to make. We need beautiful things, we need people that really care about that output. But I do think that that shift has made me a better designer actually. And at least a designer that is more of a listener in that process too.

Yeah, and I think for me as well, with design thinking in any form of design, the excitement comes in not knowing because there is a certain tipping point in design thinking, a certain tipping point in health design where, ah, this makes sense because actually that last 10 per cent's really bloody easy.

Yeah. Ah it's this colour, it's this size, it's this need. 

But to the problem is actually the journey, which I think as well, a lot of people are starting to understand and enjoy with that collaborative approach where you actually have evidence to support your thinking and the outcome where if you are challenged, you can actually support your arguments through research, through collaboration, through, actually discussing the problem with the users.

Absolutely. I completely agree. 

Yeah. So just before we finish up, what do you think is some take home messages for people in the world of health design? People in the world of design, people who are actually designing these hospitals and creating a solution to a problem for patients in a hospital in the governance?

Matthew Manos: Yeah. Gosh. And that is such an exciting project to be working on. So anybody that's listening, what a cool opportunity that you have. 

Again, my view, my recommendation especially if you are working to design a hospital and you're working to, let's just admit it, right, create a space that people do not want to be in, right?

Certainly there's cases where someone enters that space and they're having the worst day of their life, right? I think that that is such an important thing to remember when designing and it should really drive the ethos home of we need to involve people, we need to listen to people.

What is scaring people about hospitals? Is it that really bright light that reflects off of that really shiny floor? That just doesn't feel like home? Is it the endless hallways? Is it the fact that every door looks the same and there's no person in that room, it's just a number in that room?

I think that these are maybe existential questions a little bit, but questions that are important to think about, and you might have some of those answers because we're all people that engage with these spaces. And that have relationships with these spaces, but your relationship might be different than the relationship of others.

It will be different. Right. So for those that are listening that are in this space, I would really encourage you ask people... hey, what's your least favorite thing about a hospital, what is the thing about a hospital that's made you uncomfortable?

Those are really important questions to ask.

And then you can also ask questions like, what would your dream hospital look like? You can actually invite a few people at a park bench, who knows? Draw up some plans together, right? 

That won't literally be what the hospital looks like, but you'll learn a lot from that. And I think that that will really inject sort of this design strategy, design thinking type of ethos into it all and would just be really exciting to see. 

David Cummins: Yeah, I think what you've really touched on there is the collaboration of design, construction, emotion, patient care, best practice, infection control. All rolled into one, which I think is such a complex beast of health design, which is what everyone loves about it.

But to be able to absolutely nail all those needs is what really makes a good health designer. So I 100% agree with your comments. 

Matthew Manos: Awesome. Well, thank you. Thanks again for having me too. 

David Cummins: That's all right. Thank you Matthew. It's been great listening to you. I've tremendously enjoyed it.

And I absolutely love your passion for health design and also for design thinking, especially what you're doing over there. 

Your research has been fantastic and certainly helped me with my studies. I hope to listen to you more and also actually read more of your 

Matthew Manos: Awesome. Well, thank you so much, David. Thanks again for having me, and thanks everyone for listening. 

David Cummins: That's all right, thank you Matthew, for your time. 

You have been listening to the Australian Health Design Council podcast series, Health Design on the go. 

If you would like to learn more about the AHDC, please connect with us on our website or LinkedIn.

Thank you for listening.

David Cummins: G'day and welcome to the AHDC podcast series, Health Design on the Go. 

I'm your host David Cummins, and today we're speaking to Adjunct Professor Warren Kerr AM. 

For over 21 years, Warren has been the National Director of the Health Portfolio for National Architecture and Planning Practice, Hames Sharley. 

Although he has been a supporter of the AHDC since its exception, he has only been an active member of the AHDC National Committee for the past five years. 

Welcome Warren, thank you for your time to be here.

You have had a very interesting career over the last 20 plus years, and for anyone who has anything to do with health design in Australia for the last 20 years whether it be locally over in Tasmania or Brisbane or Perth, everyone has heard the name Warren Kerr. You've obviously made quite a big impact into the world of health design.

Where did that passion come? 

Warren Kerr: Well, I've always wanted to be an architect since I was about 10 years old, but my career direction was set when I won a Commonwealth cadetship during my architectural studies at the University of Western Australia. 

My specialisation in the planning and design of hospitals commenced early in my architectural career when I was invited to design an outpatient’s clinic for a repatriation hospital, and then major extensions including wards and theatres. 

One of the outcomes of winning a Commonwealth cadetship is that you are then bonded to work for the Commonwealth Government for five years. Given that the course length for architecture is five years, this meant that when I graduated, I had a position within the Commonwealth Department of Works in Perth, and as luck would have it, I was assigned to the hospital's design group who were then looking at the redevelopment of the repatriation general hospital at Hollywood in Western Australia. 

After doing that for a few years, I was then promoted to a specialist hospital design group in Canberra where I had the opportunity to work with some of the best architects in the world in healthcare planning.

This time in Canberra also resulted in my lifetime interest in not only architectural practice, but also in research and advocacy. I ended up becoming interested in research because I was assigned to the National Hospital and Health Services Commission, which had then been set up in Canberra under the leadership of Dr Sidney Sax, who was one of the preeminent exponents of health planning in Australia. 

Sid was the person who basically created the health planning profession in Australia. 

I also became involved in advocacy through the Institute of Architects, and this started quite simply by me going along to an Institute of Architects meeting and suggesting that there were a number of aspects that the institute could undertake on behalf of architects and then being asked to join a committee, and that resulted in me getting actively involved. 

After working in Canberra in this field for a few years, I came to understand that I needed greater specialisation in my career, and that led me to undertake a Master's of Health Administration at the then preeminent school in Australia, the University of New South Wales.

So, on the basis of having those skills and that knowledge, I was very interested then to pursue my career in this field.

David Cummins: That is a lot to take on board and I can't wait for over the next half hour to unpack a lot of that. What year did you finish your architecture degree? 

Warren Kerr: I graduated in architecture in 1974 and then commenced with the Commonwealth Department of Works in that year and after spending a couple of years in Perth, then went to Canberra where I ended up specialising in that area and that special group in Canberra was doing projects all around Australia and including the Northern Territory, the Australian Capital Territory, and any overseas aid projects that involved hospital design as well. 

David Cummins: Even more recently, I'm actually doing a lot of research myself on health design in Australia and still as a profession, they say it's actually one of their least researched professions in the world, especially when you compare it to medicine, to sports, to physiotherapy, to dentistry. 

To any other health profession, it's actually one of the least research professions, although that does seem to be changing dramatically.

So back in the 1970s and eighties, how did you know what was best practice? Was it through user groups? Through conversations, because there was very limited research back then. 

Warren Kerr: Absolutely. 

And it's an unfortunate aspect, but you are quite correct that the architectural profession is way down on the, the research scales.

Because of my interest in research, I've also become involved in university education and research and as you mentioned earlier, I'm an adjunct professor at the University of Western Australia, have been a visiting professor at the University of New South Wales.

During my period there, I worked with Jane Carthey to set up the Centre for Health Assets, Australasia, which was the first national research centre ever devoted to hospital planning and design in Australia. 

And that existed from the 1st of January 2005 through the 30th of December 2010, and made a huge inroad in setting up the research protocols for the hospital planning and design sector, and also resulted in the creation of the Australasian Health facility guidelines.

David Cummins: Yeah, and we thank you for that. 

And even then, in early two thousands, the research was so limited, especially in today's world and comparable to what is best practice and what helps improve patient care through better design. 

Warren Kerr: Absolutely. And one of the main highlights for my career has been working with Professor Roger Ulrich on the $2 billion Fiona Stanley Hospital Project.

Roger is one of the world's preeminent authorities on evidence-based design in healthcare design, and he introduced me to Kirk Hamilton, who was a colleague of his at Texas A&M University in the United States and together we've been working on research projects and looking at how best we can utilise the results of their research in Australian conditions.

David Cummins: So, getting back to the 1970s and eighties, how did you design buildings back then? Was it based on a commercial decision or was it based on patient care, or was it based on what you thought might work?

Was it a lot of trial and error? What was the evidence to support the design back then? 

Warren Kerr: One of the benefits that I've had in my career is that when I was selected for this specialist hospital design group, one of the prement architects in the Department of Housing and works as it was then known, responsible for hospital design had set up the hospital architect training scheme. 

And that took architects who are interested in this field out of their day-to-day designing role for 18 months to two years and put us into hospitals so that we could actually work in all the various departments of a hospital.

So I had the opportunity to work in the operating theatres in the neonatal intensive care unit in all the various different sectors and gain an understanding of how each of those departments within a hospital actually operates. Where the scout nurse goes in an operating theatre, how the CSSD operates, what are the key aspects in terms of food service delivery, et cetera.

And that gave me a great understanding. Basically, empirical research so that when I went back to designing hospitals, I had that hands-on experience and therefore knew what was required in each of the areas, and more importantly, knew what I didn't know. And therefore, when to ask questions about options that would need to be considered in formulating a design for a hospital.

David Cummins: There are so many amazing things that you just said then. 

The fact that you as an architect have the self-awareness of knowing what you do and don't know, especially knowing, especially in a health project that not everyone knows everything.

It very much is a team effort, which is what I love about health because I know what I don't know, and I also know where to find the answer. 

But I do find sometimes in the health profession, you get certain stakeholders who pretend they know everything, and I think that's where sometimes some complications arise with health projects. But if you have a good team that is able to be listened to, listen, ask questions, and work together, that that really is the definition of success and a good project.

Warren Kerr: Absolutely, and certainly early in my career, I discovered that many of my clients didn't have a good understanding of the design and planning process, but they also didn't have an understanding of how to design healthcare systems to provide me with a proper brief so that I could give them the best design for that.

And therefore, that was the reason I took the decision to undertake a Masters Degree in Health Administration so that I would understand from their point of view how hospitals operate, how the key issues that they would be looking at and how best to incorporate those in the design. 

One of the aspects that came out of that was a change in my design philosophy.

Up till that point, I had thought that I would be best designing the best building for a group of practitioners to then undertake the delivery of healthcare services. But after that, I decided that I would be best off designing the healthcare system in conjunction with my clients and then the building is part of the enabling factors for that.

Just like a scalpel in a surgeon's hand is part of the enabling factor to enable them to deliver their services. 

So rather than the building being the preeminent task, it was the design and delivery of the healthcare system and how that could be best undertaken.

David Cummins: Yeah. I a hundred percent agree.

And you touched briefly there about research and this is actually the start of our AHDC podcast series on the research series so it's a great honour to be asking you all these questions, but how important do you think research is for health designer?

It seems now through my research that journal articles, and we've got the year of health design at the moment... it seems like Australia, if not the world, is maybe 20, 30 years behind where you were in the 1970s, 1980s. And it's only now where good research, good innovation is coming through that does actually have that clinical support for patient care.

Warren Kerr: I think research is absolutely vital and as I said earlier, one of the outcomes of setting up the Centre for Health Assets Australasia, which was the first national research group established in Australia to look at this particular field, resulted in the Australasian Health Facility guidelines and that has been fundamental in assisting all architects to have similar standards, similar goals, similar opportunities, and a basis from which they can then either enhance or deviate, but according to a known basis. 

And from my point of view, it is a great outcome that I'm very glad is now being continued. I would like to see a new National Centre for Health Research, and through the Australian Health Design Council, we're obviously endeavouring to raise the profile of research in this sector of our industry, and I believe it's absolutely fundamental to improve the way that we both design and operate our healthcare facilities.

David Cummins: Yeah, I agree. 

There's actually now a new journal, I think it's called Health Design, which is a very good journal and there's even now some great books. 

I think one of them is called Health for Design, so there's actually all these new books and journals coming out, which have only been the last four to five years which again, you know, someone that's been building hospitals for over 30, 40 years you are way ahead of the curve. 

Warren Kerr: Well, one of my colleagues I mentioned earlier, Kirk Hamilton, he made the discovery in America that all the various research papers that were being undertaken, and there weren't many, but if it had been designing a physiotherapy department, for instance, it may end up in a Journal of Physiotherapy.

If it was an operating theatre, it may end up in a medical journal or a nursing journal. 

He therefore decided to set up the Health Environments Research and Design journal in the United States as the one go-to source for articles on the planning and design of healthcare facilities and he's still the co-editor of that, along with Janelle Stickler, and they have been developing that journal for many years. 

They kindly invited me to be on their advisory board and herd as it's known in Colloquialism is a great resource for having all that information in one place and progressing the state of the art in that particular area. 

David Cummins: Yeah, it's very impressive. 

Getting back to your personal research, I know you've done a lot of research yourself, but do you mind telling our listeners about some of your personal research and how it's helped improve you as a practitioner and your health design of your projects over the last few decades? 

Warren Kerr: Certainly very happy to talk about the personal journey I have in working with people like Roger Ulrich and Kirk Hamilton in evidence-based design Looking at better ways of planning and designing hospitals. 

We had the opportunity to get Roger Ulrich involved when we were doing the design of the new $2 billion Fiona Stanley Hospital in Perth. 

And when we received the brief for that hospital, we had a normal brief at that time in Western Australia, which was a mixture of single rooms, two bedrooms, four bedrooms, et cetera which resulted in about 23% of the patients had the opportunity to be in single bedrooms.

Roger on the basis of the research that he'd undertaken in the United States and around the world suggested that that should be amended.

He made a recommendation to our client, the WA State Government, that they increased that to 80% single rooms. 

They looked at the research that Roger was able to provide and the reductions that he could show in length of stay and having reduced likelihood of disease transmission, et cetera, and agreed that they should proceed with that. 

So the brief was reformulated and Fiona Stanley Hospital was the first major hospital built in Western Australia, which had primarily single bedrooms. So that's one clear example of the impact that researchers had on our practice as a in designing major hospital facilities.

David Cummins: Yeah. And that's a really, really good example.

You personally have done a lot of research yourself over the last few years. What would be some of your favourite teachings from your research? 

Warren Kerr: There are very specific areas that come out in terms of the relationship between hospital beds and the ensuite facilities that are normally provided in those, and they're better described with a drawing and an image so that you can understand what I'm making.

But for many, many years, people in hospital design had beds in rooms with the ensuite across the room and similar to many hotel rooms, et cetera. The research then found that many patients who were trying to get up during the night to utilise the facilities in the ensuite collapsing between getting out of bed and getting to the ensuite.

Research dictated that it was far better to have the ensuites facilities near the head of the bed so that you would hop out, grab onto a handrail if you needed it, and guide yourself round to the entrance to the ensuite without incurring any falls or slips that may end up with you staying longer in hospital than required.

David Cummins: Yeah, that's a really good example of what not to do. 

Keeping that in mind then, how come some designers and some hospitals still get it wrong today? 

Warren Kerr: I think a lot of that is basically on the basis that many practitioners don't have the knowledge and skills and experience that some of the more-senior practitioners have.

It takes many years to become competent in this field and there's a lot of learning to do because you are looking at bridging both the professions of architecture, health planning, research, and hospital operations and with technological change, it's a lot to keep up with. 

There was a research study some years ago where they put a group of pharmacists in a room, took them away from their day-to-day operations and just asked them to try and keep up with all the latest research that was in the various magazines that were coming out.

And after six months something like four months behind.

David Cummins: Yeah, I totally agree, I think there is certainly vast opportunity for people to listen and learn from those that have built and those that are about to build as well. 

But I do think part of that is the builders as well. There are some amazing builders out there who have built many hospitals and understand health, and there are some who have not done that. And unfortunately that means sometimes some errors are made, especially with an infection control where a simple thing like a perforated ceiling versus a solid ceiling might be the difference between infection control and impact in some patients or not. 

So I do think that's why it's such a complicated beast that really is a team effort to try and get it right. 

Warren Kerr: Yeah, and I mentioned earlier that one of the other phases of my career I've been quite involved in is the advocacy side of architecture.

And through my efforts with the Institute of Architects, I've ended up becoming the WA State President for a number of years, and then the national president of the Institute of Architects and I, during that period, had some very interesting discussions with architects who believe that they can design any type of building.

Whereas I've always been a preeminent advocate for the fact that specialising in health, and it just is so complex and takes so long to learn, that the best practitioners are going to be those who specialise in this field. 

And it's, we've had some good discussions over a couple of bottles of red to articulate that point of view, but it's now being, I think recognised around the world.

One of the other honorary roles that I undertake as being Australia's representative on an international forum set up under the auspices of the World Health Organisation and the International Union of Architects, where we share information on hospital planning and design between 70 other countries.

And that allows me to have an understanding and a perspective on how other professions in other countries of the world are pursuing this particular sector and improving their skills and health facility planning and design. 

David Cummins: Yeah, it's very, very impressive. 

Keeping it in mind, your career over the last 30, 40 years?

Warren Kerr: Haha! probably getting onto 45, I think... 

David Cummins: What do you think the future of health design is going to look like in the next 30 to 40 years? 

Warren Kerr: I think the major issue is just going to be the speed of change. I mean when I started in my career, you were often asked to undertake a hospital project to work very closely with the clients, and over a period of years gave them a new building.

And then there was almost a parting of the ways because you then knew that you probably wouldn't be seeing them for another decade or so before they would need to alter any of the buildings, the facilities et cetera that they required. 

Normally in those days, you did a projection of projected need to meet that need that was not just for current need, but projected out a number of years in the future. 

However, now you finish a building and within a couple of years, the rate of change and technological changes mean that there have been improvements in radiotherapy equipment, in radiology equipment, in the way that investigative surgery is undertaken, and therefore the hospital needs to be almost in a constant period of upgrade and evaluation of having the latest information on the latest technology. 

Many of the larger hospitals in the US and Canada now employ a healthcare architect on their staff, just to keep them up to date with what facilities they need and how best to accomplish that within the infrastructure that they have currently.

David Cummins: It's very impressive, especially to look at some of the research that's coming out from overseas, but also some of the research that's coming out from Australia. 

I do think health design in Australia, in many ways, world leaders, but in many ways we have a lot to learn as well. So it is always important to keep an eye on what's happening overseas while also sharing our own information I think.

Just before we do head off, what would you say is one of the words of wisdom that you would give for people in the industry who really just want to try and make it work and really get involved in this industry and also, you know, have a long 45 year-plus career like you have.

Warren Kerr: Well, I was very fortunate in my initial placement, whether I ended up with a good mentor and someone who was at the cutting edge of hospital planning and design in Australia at that stage. And that gave me a head start and understanding of the field and the breadth of it. 

So I would suggest that for a person just starting out on their healthcare design and construction careers to find a good mentor to work for someone who has the required experience in the field, and also to gain additional qualifications in healthcare planning and design.

I'm currently attempting to set up a master's in this field in conjunction with my colleagues at Texas A&M so there is no master's program in hospital planning and design in Australia at the moment.

I believe that it would be of great benefit if we could get a specialist program in that area and have related research in that field.

Obviously the other advice I would give people starting out in their careers in this field is to join the Australian Health Design Council and get actively involved in our activities. 

David Cummins: Yeah, I agree and I think things like the podcast is a great way of getting our message out especially for those in Australia and also overseas to show exactly what we can do.

Warren Kerr: Absolutely. 

David Cummins: Warren, we're out of time, but I did want to say thank you so much, not only for your time but also for your effort and dedication to the industry. 

Certainly you are a global and Australian leader in this space, and I think the Australian healthcare design and construction industry, thank you very much for everything you've put into this effort.

And it's very much appreciated from me and from everyone else I think as well. 

Warren Kerr: Well thank you very much for your kind comments. I have enjoyed my career and it's mainly been my love of trying to find out more information about the field in which I have been involved. 

And also to some degree you feel occasionally like a professional voyeur because whether you're designing a dental hospital or a endoscopy unit or a surgical unit, you end up going into the lives of the people who have spent their careers focusing on that aspect and learning more about the skills and expertise and their vision for the future as well. So it's always been an enjoyable task and one that as a naturally curious person, I've quite enjoyed.

David Cummins: Thank you very much. 

You have been listening to the Australian Health Design Council podcast series, Health Design on the Go. 

If you would like to learn more about the AHDC, please connect with us on our website or LinkedIn. Thank you for listening.

David Cummins: G'day and welcome to the AHDC podcast series Health Design on the Go. 

I'm your host, David Cummins, and today we're speaking to Sarah Marberry, healthcare and senior living design knowledge expert and marketing consultant and writer. 

Sarah began her career as a communications specialist traveling across America and Europe when fate introduced her to the world of health design and she hasn't looked back.

Sarah had a strong career in the world of health design and as a communication specialist, we welcome her to our series on the Art of Communication for Health Design. 

Welcome Sarah. Thank you for your time. 

Sara Marberry: Hey David. Thank you. I'm glad to be here. 

David Cummins: So, I was just speaking to you earlier and you were talking about how you started your career in communication. So how did you end up from communication into the world of health design? It seems like a bit of a stretch for some people. 

Sara Marberry: When I graduated from college, I went to work for the Merchandise Mart here in Chicago. I still live in the Chicago area, and the Merchandise Mart is the world's largest design center.

So I was introduced to this whole world of design that I knew nothing about. And I worked for the Mart for a couple of years and then I moved to the New York area and I started working for a magazine called Contract Magazine as an editor. 

And there I learned everything there was to know about commercial interiors and peripherally knew something about healthcare.

But I wrote a couple of articles on healthcare projects and stuff, but mostly the focus at Contract Magazine was on corporate offices, so healthcare wasn't a big deal back then. This was in the early, early eighties. 

But I was at a conference one spring, I think it was, and I met a man at this conference who walked up to me and said, hi, my name is Wayne Ruga, and "I'm starting a healthcare design conference" and like any editor or reporter does, I just said, "oh, yes, send me information on it". 

Well, Wayne not only sent me information, but he got me involved. He invited me to be on the advisory committee and he also invited me to be the MC of the very first event that was held in 1988 in Carlsbad, California, and, I ended up being the MC of that event for 10 years.

And it was an amazing thing because when that first symposium was held, it was the first time that people in the healthcare design field came together as a group, designers and providers and product manufacturers. So it was really kind of the birth of that industry here in the United States.

David Cummins: Yeah, that's phenomenal because the birth of Australia with research and health design in Australia has probably only been around for about 10 plus years. So, for that to have happened so long ago it's very, very amazing. 

In Australia we've got the Australian Health Design Council, we're starting to get a lot more research into the world of health design. But I would say America and certainly Europe have been the leaders in that. So, to be part of that, birthing of such a great movement must be very exciting. 

Sara Marberry: Yeah, it really was. My hat goes off to Wayne because he was the visionary who brought these incredible people together.

And he put people on the board that were doing amazing work, and he brought speakers to the event who were just incredible. And so, it was this period where, it was kind of like when you come to the symposium, you're like, "I found my people". 

These are people who understand that the design of the physical environment affects patient and staff outcomes. There was a lot of excitement around it. 

 From the symposium, I was also one of the founding board members of the Center for Health Design, which is a non-profit research education advocacy organization. And we founded the center because we wanted to fund research and you had to be a non-profit to fund research or get funding from government agencies to fund research.

And so that was really the impetus for pulling that organization together. And the center still exists today and is still leading the charge in the area of evidence-based design and research for healthcare facilities. 

David Cummins: I would say most people listening would know about that and if you don't, you've been under a rock because it's very, very world famous, That research. 

I personally have a physiotherapy background, so we were always taught, the way I was always brought up, is "what does the research say" where basically you're not allowed to have an opinion because if the research doesn't support it, it probably isn't there.

You can have theories, but " what does the research say, how is that better?" And so, I've actually brought that into the world of health design where you try and find best practice because that has the best clinical outcome. 

So, I absolutely love what you've done and I’m very grateful for what you've done.

I think a lot of architects and patients and practitioners and hospitals have benefited from what you guys started years ago. 

Yeah it truly is remarkable. I had a personal experience two years ago when my mother was in the hospital. She had suffered from Alzheimer's for 13 years, and at the end of her life, she had a fall.

She was near 90, and we made a decision to put her into hospice care in the local hospital. And when I arrived at the local hospital to this hospice unit, and I went to my mother's room where my father and my brother and my sister were, it was this amazing patient room. It had all these windows, it had a family zone. 

When I entered the room, they were playing the care channel, which actually used to be one of my clients, but it's music and video that is nature programming. 

And so, later I said something to one of the nurses, I said "wow, you guys have done everything right here, you've created a patient room that really supports the patient and the family". 

And she said to me, "oh yeah, that was very important to us and we wanted to make sure that it cut down on the family stress" and it really did provide a healing environment for the patient.

And I thought, bingo! That's why we started the Center for Health Design and we did all this work. The work I've been doing, it was so gratifying to hear somebody on the caregiver side. She got it. So, it validated all the work that I've been involved with all these years.

Yeah, and that's humbling to hear. And certainly in Australia, our design is certainly that way as well, where it's not just a place where sick people heal. It's a place of wellness, it's a place for collaboration, it's a place for grieving, it's a place for coming together, it's a place for families and for staff.

I certainly think the world of health design, certainly in the last 15 years since I've been in it has certainly evolved. What do you think some of the changes have been that you've seen in the last probably, what, 40 years is it? 

Sara Marberry: Well, not quite. It's probably like 30 that I've been involved, 30 something that I've been involved in the field.

I'm fascinated with history. I think that we can learn a lot from history and I do a lot of going back and looking at things.

I think very few things are ever really new. I mean, when we put wheels on our suitcases, that was pretty new. 

But in the world of healthcare design, the things that happened that were breakthrough were things that happened in those eighties and nineties where we were looking at the importance of single patient rooms and we were looking at, things like noise and access to nature and natural light. 

And these are still things that we're doing today. So I think what has changed though, and what will continue to change is the technology that will influence how health facilities of any kind are designed and I think we're going to see more smart buildings, where the building itself, the building systems, the furniture, the materials in it will all be collecting data that can inform design and really tell the building owners, how the people are using the space, how their staff is using the space.

So, I think that technology is what is pushing us into new areas where we have to find more creative and innovative ways to address things. But some of those things that we discovered 20, 30 years ago are still the mainstay of what is good design in the healthcare field.

David Cummins: What do you think some of the biggest not necessarily changes, but the biggest improvements to patient care have been through design in those years? You've mentioned nature, you mentioned greenery, you mentioned natural light. 

So do you think there's been the stable benefits for patients over those years, because still, I would say certainly in Australia we do try to enhance those principles as much as we can, but sometimes we have natural light looking into a brick wall. 

So how do we find that balance for such important design principles for patient care?

Sara Marberry: Well, there's other ways to bring nature in besides a window. There's artwork and there's interactive artwork and things like that. It's not the same looking at a real tree or being outside, but I think that the patient experience itself has benefit from this awareness that the design of the physical environment can impact the stress levels of both patients and staff. 

And so that is something that in the early, when we designed these hospitals in the forties and we buttoned everything up and they were all white and they were sterile and everybody was concerned with cleanliness, but they weren't really concerned with the senses and how people interacted with the environment. And I think that that's top of mind right now. 

And it's also top of mind that it's not just about the patients. It's about the caregivers as well. We have to create supportive environments for the caregivers and not just throw them into these sterile windowless environments.

And so I think that that thinking has radically changed in the last 30 years.

David Cummins: Yeah, there was certainly a project I worked on a few years ago where they absolutely made the surgeons and the nurses the number one priority and the environment with which they were working was some of the best working environments I've ever seen.

And the amount of staff retention there, the lack of sick days, the amount of morale that’s increased.. The clinical outcomes from this place has been phenomenal, all because they focus on the staff or their staff areas where they had common areas. And it's just amazing. 

Like it was, as I said, it was one of the best environments I've ever seen and the research is there to prove that people actually, that they're spending most of their life at that work. So they actually should improve that. 

Sara Marberry: That's great data to have because then you can take that to the leaders and say, "look this is the turn on your investment". We can do all this stuff because we know it's good for us, but, healthcare's a business, so it's also gotta make good business sense to these leaders that are making the decisions to spend the money and follow the advice of the architects and the designers to do something different.

David Cummins: Yeah. So what's something America generally is the world leader in and always gets right in health design?

Sara Marberry: Hmm. Well, I think that varies hahaha but I think there's a lot of health facilities around the world that still have double patient rooms and that really doesn't exist here anymore.

The research was so strong about preventing infection and now everybody understands this. Covid has made everybody understand. Nobody's building any hospitals with double patient rooms and even ones that had them are renovating and making them all single patient rooms.

David Cummins: Correct me if I'm wrong, but during Covid, obviously there was a huge influx in a place like New York where there was just such high populous of people and people have been treated in corridors and so forth. Is it not true that a lot of hospitals in America hadn't prepared for isolation rooms? That was what we were hearing over here?

Or was this the huge volume of people that were relying on the health system, that's where infection control procedures weren't being followed. 

Sara Marberry: Yeah, I think it has more to do with volume than the fact that there weren't isolation rooms. And typically isolation rooms are just a small portion. There may be only a few beds dedicated to that. 

And when you have hundreds and thousands of people coming to your hospital that are sick with the virus, you can't possibly turn the beds in your hospitals into isolation rooms. 

But that's certainly where the current thinking is how do we look at these. Everybody calls it design for flexibility, but how can we adapt spaces for different uses at different times?

And I like to think that that's more about resiliency than it is flexibility. Everything we're talking about in the wake of Covid is how do we build facilities that are resilient to these health emergencies?

And certainly in America there are certain healthcare organizations that have very sophisticated isolation units and Emory University is one of them that has done a lot of research in that area.

So not every hospital has, what I would say is the A level isolation rooms, but most of them are equipped to have some degree of isolation rooms in them. It was just the volume that overcame them. 

David Cummins: Yeah. Okay. I mean, every hospital had images like that, but certainly the images we saw in America were quite distressing.

Just the sheer volume of some hospitals, and it was obviously in-patients and staff got impacted negatively from that wave. 

So what would be something that America can improve on with your design?

Sara Marberry: Hmm. Something that America could improve upon...

Well, I think that what I just mentioned is a big thing. Being able to adapt spaces to different uses. This has been a trend in America, a while, I think all over the world, but the use of outdoor spaces and really incorporating them with intent and purpose into healthcare facilities, and knowing that you may have staff that are in indoors with all this protective equipment on all the time, but where can they go to take it off?

Well, outdoors is a perfect example of that. So I think the integration of outdoor spaces is going to continue to be very key, but, everybody's talking about what I call resilience, but this flexibility and adaptability and being able to pivot like that. 

David Cummins: Yeah, it's something Australia does very well.

We do prioritise a lot of outdoor space. Obviously we've got great climate, so a lot of outdoor space, a lot of indoor outdoor space as well. We've actually got a podcast series on the importance of landscape architecture and how it improves patient care. 

So we do prioritise that a lot because we generally have more space and as I said, the better climate which is important as well.

Sara Marberry: Certainly there's a lot of areas where things can be improved and there's a lot of inner city hospitals that struggle with a lot of these issues because like you said, they don't have the land to make outdoor spaces or they don't have the money.

Their city, their county, so I think there is that. You have the haves and have nots in America but the good news is I think that there is more of a widespread recognition that the design of the physical environment is really important to outcomes and even if the only outcome is preventing the spread of infection.

David Cummins: Yeah, exactly.

I know you don't identify yourself as a researcher, but you've obviously done a lot of research. You're obviously very well versed in the world of health design. What do you think is some of the areas that need more research in the reference to.. Is it patient care? Is it the patient journey? Is it infection control? Is it the importance of mental health? 

What areas do you think people haven't really touched on that requires a lot more research? 

I think that the research In all areas could still be bumped up. When we did our first LIT review for the Center for Health Design back in, oh gosh, I can't remember when it was like 94? The researchers found 83 credible studies that linked the design, the physical environment outcomes. And then a couple years later when it was redone, it was 400 studies.

And then the last time a comprehensive LIT review was done, I think that the number was 2000. And that's still relatively small in the realm of research but now on the Center for Health Design's knowledge repository there's over 6,000.

They're not all research articles. A lot of it is research, but also other types of resources that talk about the design of the physical environment. So, in terms of areas that could use more, it's certainly one that is very well researched is nature.

I don't think we need any more nature research. I think certainly as a result of covid, there's a lot of research on infection control and how design can mitigate that. I think we still need more on that.

One of the best articles I've read is by researcher Dr Jane Carthey and she actually dissected into the benefits of better user groups for the process of health design. Her research found there was basically minimal research into the world of user groups because everyone has been taught how to do it but her research completely broke that glass ceiling saying "actually we've been doing it wrong". 

Where you can't actually have a cookie cutter approach to the world of user groups because at the end of the day, every user is different. Your stakeholder is different, every hospital is different.

And so this whole idea of every two weeks, and I personally used her research quite in depth at one project years ago, and we actually improved our design program by over eight weeks. Yet another team on a very similar project, it actually got pushed out by six months purely because they weren't using the basic principles of collaboration, consulting, understanding, respect. 

And they'll push into a program as opposed to push into the needs of the hospital and the patients and the users.

So I found that really interesting. I always think more research into the process of design thinking, into the process of consulting, into the process of how do we actually get better outcomes from the needs of the stakeholders and the patients.

I find that process very interesting to try and actually improve it because if you can enhance and streamline that process, we'll actually get better clinical outcomes as well.

Sara Marberry: Yeah. Yeah. And I think that's very interesting. Not being a practitioner, that's not quite what I think about first and I'm more about like, what are the things that people are grappling with that need more validation? 

One that comes to mind is this whole issue of neuro diversity and how do we design environments for people with different psychological and social needs? 

And if we do, does it really matter? There's not a lot of research on that. And another area I'm particularly interested in is the idea of a healthy building and a healthy building that does not harm people or the planet.

So in healthcare there are buildings that come close to that, but as far as I know, nobody set out to say we're gonna design a healthy building that we're gonna make this hospital healthy, that it does not harm the people or the planet. 

There's a lot of green design, there's a lot of green hospitals in America who've gathered research on the benefits of their green design but this merging of the environments that do not harm people, there's not a lot on that.

 Again, it's intuitive. 

We know if we design spaces that support people, they're gonna be happier and more productive and they're not gonna leave their jobs but I don't think there's a lot of good research to back that up. And the Well Building Institute is an emerging organization here that has its whole well building design standards. 

And there hasn't been a lot of research to look at, okay, here's a building that's been designed according to these well building standards. Did it really achieve the outcomes that we wanted it to? 

And so I think there's a lot more to be done in that area. 

David Cummins: Yeah, I think you are still part of the Paris Agreement where you're trying to drop emissions, but America would have their own emissions target, would they not?

Australia's got emissions target reduction, I think it's 30% in the next few years to 50% to 80% to a hundred type thing over the next 40 plus years. I imagine America would have similar, where pretty much if you're designing a building now you have to account for those emission targets as well, would you not? 

Sara Marberry: There's no regulations that are really mandating that. Our federal government did come out with a pledge earlier this year that they wanted healthcare organizations to sign to say that they would reduce emissions by, I can't remember if it was zero or if it was zero net by some year.

I can't remember the exact details, but there's, there's no government regulation that mandates that. It's more like, if you think it's a good thing, you're gonna do it and certainly there's organizations like Healthcare Without Harm that have been promoting this and getting healthcare organizations all over the world to sign on to reduce their carbon emissions.

But right now it's voluntary. You do it because it's the right thing and maybe it makes good business sense, which it does. 

David Cummins: I think America's actually the first worst polluter in the world of health care, as an operator, I think you're about 10 to 12%, and Australia is actually the second worst polluter at about 7% with the global average being about 3.5%. 

Don't quote me on those numbers, but I'm pretty sure I'm close. So Australia's basically double the world average and you guys are worse than the double as America as an entity for the world of healthcare. 

So obviously it's a 24 hour operating hospital, but a lot of people just say, oh well the lights are on 24 hours, it has to be. But UK, for example, and a lot of places in Scandinavia and even Canada have proven it doesn't actually have to be that way.

Yeah and what's gratifying to me is that there are more initiatives that are coming down the pike and I think you follow the money and there's a lot of healthcare facilities in America are funded by these healthcare real estate investment trusts, they're called REITs. 

These organizations are looking to give money to healthcare organizations that demonstrate strong environmental and social and governance policies. And so, some people in the financial world are saying, well we're poo-pooing this. It's just a marketing thing, are they really making money doing this? 

But I think it's an important thing. I mean, because ESG policies, every healthcare organization has them now and from a designer's standpoint, if you're a designer and you can come to the table and say, I can help you meet those goals with how I design your facility, that's a win-win for a designer.

Yeah. I was speaking to some sustainability consultants the other day and they said basically we should be the first phone call before the design team because we help work out the KPIs and if you have a healthy building or a carbon neutral building, you can actually have the potential to save, 80, 90% in operational costs, which obviously reduces the operational budget, which actually helps prevent more infections in the environment and help the world and help reduce the cost. 

So there is all these huge benefits. It's just a matter of the conversation and changing the mindset as well I think. So I do think Australia's getting there. Certainly it's been a high priority on the agenda for the last few years and I know a lot of places around Australia at the moment are trying hard to produce Australia's first carbon neutral hospital, which there's a race on at the moment, so it's actually quite an exciting time to be in Australia for that.

Sara Marberry: Well, and yeah, and I just wanna point out too, that carbon neutral is great, but I'm talking about more than that in a healthy building. I'm talking about a building that promotes healthy behaviors through its design. That's what I mean by it doesn't harm the health of people or the planet. 

So the planet is the carbon neutrality and the electricity consumption, but the health of the people is something different. That is something that is stuff like, safety and infection control and wellbeing, mental health, wellbeing and how the environment supports all of that.

So it's a two shot thing. It's not just let's be sustainable, but it's also how do we promote the health of the people who are using this building. And like I said, I don't think anybody's truly built the first healthy building yet. 

David Cummins: I hadn't even heard of it! Hahaha. So I think we need more research on that one. So that's very interesting.

What would be a take home message or something that you would like to see change in the next 30 plus years, considering you've in the industry for so long? 

Sara Marberry: Oh gosh. Something that should be changed...

That's a hard question. I think that there's still some misperceptions in the public that come from bad reporting or just inaccurate reporting that these buildings cost a lot of money. They don't.

You just have to make the right decisions and in the end there's ROI.

I always go back to one of the Center for Health Design's board members Derek Parker, who always said that he could not do his best work without having a client that had the vision, because he couldn't go in and convince them to do something. They had to be willing to take a leap. 

And so I think that there's still a lacking in leadership in the understanding of these things that we've talked about here. Certainly healthcare leaders, healthcare CEOs of hospitals and hospital systems in America have a lot of things that they're worrying about.

But if they really realized how important the design of the physical environment was to their whole business operations, they would be paying a lot more attention to it. And I still think there's a lack of that in this field. And some of it may be due to public perception, what they read in their local newspaper or see and maybe it may be the people that they're working with have not enlightened them.

But I still think that there's a ways to go in that area. 

David Cummins: Yeah, I think that's a really good point. I think that's universal as well. Basically, culture comes from the top and the decision makers are the ones that ultimately need to make those hard calls and be visionary for the future.

Because if we don't have those hard decisions made now, the design overall will fail and the hospital itself eventually will be challenged as well. 

So I think that's a really good point. I just wanted say thank you for all your hard work over the last 30 years plus, I mean, without the Centre of Health Design, without the world of health research, certainly we would be back in the 1940s hospitals, which is just a brick wall and squares and white walls. 

So I do think what you have done from the center of health design has really helped change the world, change America, and certainly change Australia's world of health design.

We are a little bit behind, but certainly on a fast trajectory. Thanks to you guys paving the way, so thank you very much. 

Sara Marberry: Well, you guys are doing great stuff too. I'm not as familiar with the Australian market, but what I have seen, I think you're doing a lot of good stuff.

David Cummins: Thank you so much Sarah, thank you for your time. 

You have been listening to the Australian Health Design Council podcast series, Health Design on the Go. 

If you'd like to learn more about the AHDC, please connect with us on our website or LinkedIn. Thank you for listening.

David Cummins: G'day and welcome to the AHDC podcast series, Health Design on the Go. I'm your host, David Cummins, and today we are speaking to Associate Professor Aidan Rowe, Professor of Design Studies at the University of Alberta in Canada. Beginning with a Bachelor of Fine Arts, Aidan continued his studies into the world of design-thinking and continued to explore the benefits of design research across the globe, obtaining multiple degrees and teaching in the UK at the University for the Creative Arts in London.

Aidan has been working in Alberta for over 15 years and he's continued with design-thinking in the world of health, which is why he's such an important guest today for our design-thinking and Consulting Research series. 

Welcome Aidan, thank you for your time to be here. 

Aiden Rowe: Thank you for the invite, David.

David Cummins: So that's a lot of degrees. How many degrees do you have to become an Associate Professor? 

Most people would have at least three degrees. That's what I have as well as a Certificate in Higher Education Teaching. But most people would have three degrees. 

Aiden Rowe: And they're predominantly based around design-thinking and arts, correct?

Yeah. So my background is coming from the design side of things. my original degree was what we call Visual Communication Design here, and that might be called Graphic Design in other types of institutions. And then after that two research degrees that broadened that out, but always situated within design and always situated kind of within a human centred approach.

David Cummins: And for those who aren't a hundred percent familiar in design-thinking, can you just briefly explain what design-thinking is and how it can benefit pretty much any problem in the world? 

Aiden Rowe: That's a big ask David. Design (and this changes and works from it) is after somebody named Herbert Simon, is the idea of understanding our situation as it is.

And, seeing a change, seeing some improvement within there, and then, figuring out how to get there, how do we get from here to there? so that might be really small, but that could be a very small, very focused sort of problem or, issue to sort of address. But as we know as well, that might be a really massive what's often called a wicked problem.

How do we apply design to that in a human centred approach? Is broadly what my research looks at. 

David Cummins: Design-thinking's been around in Australia for a little bit, but certainly not as long as Canada, it seems. And we were always taught with design-thinking 90% problem, 10% solution.

And I still find today, especially those that have not actually undertaken design-thinking training. They always try to go to solution mode thinking what their experience or their ego or their, peers might think is the best solution. But if you actually do take that extra time to understand the problem and have empathy and non-judgment and really do the research, the outcomes are generally pretty phenomenal.

 What do you think about, the idea of a solution based answer as opposed to a design-thinking? understanding of the problem? 

Aiden Rowe: I was just working on a paper that speaks kind of exactly to that. You hit numerous really big things there.

Historically we think of design and even designers do, as producers of really nice, attractive things. Things that are impressive in some sort of way, whether that's graphic design, furniture design, fashion design, all these sorts of areas. And as you said, this idea of actually the investment in understanding the problem or 'the situation' to actually inform how it moves forward.

And even with my students, there’s often the use of the word solution, and I think even that's a problematic word in the fact that, if anything, there's maybe 'solutions', a variety of these things, but we also know, generally standing back that. 

Anything that we're going to put forth as a design response to something but Lord knows it seems a lot of things that we create to solve something, create many more problems or many more issues through there.

But I that idea you said that full waiting upon understanding the problem, and that understanding often really also only comes through conversation with people and working with the actual sort of people who are involved in here. One of the things that often happens in design is that, you're an outsider.

 You've been asked to help resolve something. And often you are most likely maybe not the client or the user of that. And so how do I understand that? And that's this kind of often what I would call a participatory design approach of, okay, let me try and really kind of understand this.

How does one, as a designer check one's ego, check a rush to a solution?

There's an idea of the designer as a facilitator of something rather than necessary solver of problems.

It does raise many questions within there about these ideas of preparation, about research, but that investment at the beginning really pays off at the end. 

And one of the things that I think is actually really interesting is that often design-thinking or ideas around design-thinking may be often more successfully grasped and utilised by non-designers.

And that's one of the really powerful parts of it, is that... how could we have this kind of process that's open and a means of working that really opens it up? And again, that's a bit of an ego issue. I've spent a lot of time working as a designer, being educated as a designer, teaching as a designer.

And there's something really contradictory about spending all that time and then also sort of advocating that anybody could be a designer if you actually sort of take this approach. 

And so, I think there's always a lot of unpacking and unpicking of like, what does it mean to be a designer? What are we doing?

How do we shift that idea of what I often talk about is rather there's a real focus on the kind of outputs of design, the things we make versus the outcomes. Like what has actually changed? What happens? How do we measure success within something, which is part of, as you said, that process, right?

If we don't know how we're going to measure success while we're actually developing this, what's the change, which is going to be good, how do we get to the end where we can actually say, wow, yeah, that did improve things or didn't, or, some of these things may work much better than thought, but yeah.

An attempt to check that ego, an attempt to invest in the process, an attempt to trust people and sort of work through there is integral. 

David Cummins: Yeah, I hundred percent agree. So you're talking earlier about a 'wicked problem' and I imagine most countries in the world would consider, especially more recently with Covid and the aging population, healthcare a wicked problem where there is often multiple factors at play.

All big, big factors in themselves when it comes to one big group, which is certainly some of the problems we have in healthcare in Australia, and I assume similar in Canada. Your research . Recently has been more focusing on healthcare as a design wicked problem, and especially taking on board those considerations of the aging population and chronic disease and things like that.

 Do you mind just telling those people that haven't read your research about your more recent research into healthcare and how design-thinking has helped? 

Aiden Rowe: Yeah, there's, there's probably a few strands of the research that, again, working with many different sorts of people. Some of the recent work that I'm doing right now with two colleagues involves looking at health education itself, so how doctors, let's say, are trained in medical school.

So I've done work with them on how you might apply design in that space. How might there be a design-thinking process and how might this, as a provider of healthcare, how might that allow us to reframe how we think healthcare works, how we might respond to there.

So I teach in a variety of different contexts within there in healthcare. So that's one sort of direct way. A paper published this week starts to look at the environment, w hat we call the emergency room or the A&E in, let's say England. How the design of that space itself may facilitate and or hinder healthcare processes.

And trying to look very broadly at those healthcare processes as well. We often really think of the healthcare process, let's say in the emergency room, really only being, I'm a patient and I need help, but there's a lot of interrelationships there as well. If we think of hierarchies of medical staff , if we think of the people who are sick or needing attention but they're also usually brought in by family members.

What does care look like before going to an emergency room, what does it look like after? So a recent paper that will be published right away with a colleague, Michelle Knox, it's a systematic review of looking at other people's research to better understand how might the design of the physical environment and the processes and systems involved in there actually affect our healthcare outcomes through there.

So those are two broad areas, sort of like the idea of environments and systems and the idea of education as well as a means of addressing some of these complex wicked problems. 

David Cummins: And you said that research is about to come out correct. Cause I haven't seen, 

Aiden Rowe: Yeah it was just accepted this weekend. So that's...

David Cummins: Oh, congratulations. 

Aiden Rowe: Yeah so that'll be a paper that's in a journal called HERD (Health Environments Research & Design) and that should be coming out right away. And that's as I said, it's a systematic review on existing work around the emergency department and the relationship with design. Hopefully that's out right away. 

David Cummins: Yeah, perfect I look forward to that. 

So what were your findings necessarily with, with that one? Because the ED in itself, that's even more complex than the actual health system itself, depending on the ED. 

Aiden Rowe: Yeah. It's actually really difficult to think of a more complex environment. We're sort of looking at it. The kind of most challenging place. When I describe that environment to everyone. First off, it's an environment that almost all of us will encounter at some point. Unfortunately, no matter what, whether you are as a patient or whether you are helping somebody through that sort of process, it's pervasive in that first instance. 

Everybody will encounter it. Maybe another large factor from it is that there isn't a lot of published research in this area already. It's an area that has either been neglected or, hasn't necessarily been considered. 

 Usually design is really almost only considered at two very specific moments, especially within kind of the built environment there. Either the initial idea of like, we're going to build this hospital, and then after that very small minute design consideration. It was really interesting in the fact that there actually wasn't a lot of research.

We really (and again, there's a lot of caveats) we're looking at English language, we're looking at publicly accessible documents, these sorts of things. But we really only looked at just over 30 articles that we were able to track that really looked at emergency departments or emergency rooms and design in these sorts of ways but these identified issues around overcrowding, wait times, privacy and communication the things you would expect in many sorts of ways. 

It did uncover though, as well one of the things that we do see a lot happening is that the emergency department is also treating a lot of people.

That probably shouldn't or don't need to be there, partly they're there because of limitations on the existing systems. I can't speak for Australia, but, in Canada, I don't have a doctor right now because it's very difficult to find a doctor through there. Fortunately, I'm healthy and young-ish enough. But that's a very common issue. 

And if you don't have a doctor, if you don't have regular medical advice within there, and if you also maybe do not have the resources that many people do have, whether . Financial or access to information or the ability to understand that information.

The emergency department becomes a port of call often through there, which then obviously makes it a much more challenging sort of space. And as you talked about, Covid, aging populations, there's a variety of really, really challenging situations. 

David Cummins: Yeah, I look forward to reading that.

Your other research, I'm pretty sure it came out about 2020, so I wasn't too sure if it included Covid or not, but it was all about rethinking health through design about medication aging population and actually the healthcare system as a whole.

For those of you that haven't read that research. Do you mind just talking about that research piece in itself, and then the lead into that question is about more Covid, so I assume at that point in time, Covid wasn't really an issue for that research? 

Aiden Rowe: It was before that. Which is an interesting point to think about it, as you say, or that's obviously shifted. Almost anything that we would think about there. That was a co-authored piece with my colleagues, Gillian Harvey and Michelle Knox. 

And that was a piece where health design has probably has been a focus of this design studies department at this university for decades. But this was a piece where three of us came together with sort of three different streams of research that explored the intersections of design and health and wanted to write about that almost both to give it some context but also to give some case studies, examples and to try and situate it,

Creating an article that was hopefully of interest and valuable to both the design side and on the healthcare side. So there's three streams within there. The first stream is some of the work that I've done around education, which I talked about a little earlier. 

So I documented some work on, in this instance was offering a summer term course, so in between the normal semesters at our university that brought together design students and healthcare students, so students studying for medicine, physiotherapy, nursing, and they worked in teams together with design students to tackle health design issues, usually at the social and community sorts of levels.

My colleague Gillian Harvey, does a lot of work around information design and work around urgent care design, and so she does a lot of work around information design around urgent situations. The specific information in there is around her work, around Naloxone. For people who overdose on drugs, Naloxone is a drug that is administered to alleviate that.

But what is interesting about that situation is that often while it can be administrated in a hospital or in a medical situation, often, administered in non-medical situations. So if you go to a bar, if you go to a club, if you go to a fraternity house, they will have Naloxone kits, universities will.

What that often means then is the person who is then injecting that has no medical training is not a doctor, is not a healthcare practitioner. And so once again, that seems to me one of the most stressful, craziest times of your life, and Gillian is the person who then designs the information, the instructions on how to do that. 

And what's great about that is she's also really embedded that into our design programs here. So our students have worked on the refinement of the instructions that are included in those Naloxone kits that thousands and thousands of those have been distributed and used.

And the third part of that is Michelle Knox's work. She was a graduate student here and she does work around What's called MAID here, (Medical Assistance in Dying). For people who are looking for ethical choice in ending their own life, if they let's say have terminal diseases, if they know that they would be much more at peace in making those choices.

And so this was a study looking at locations of dying for people. So she did an ethnographic research based in both a hospice within the province of Alberta as well as a hospice centre inside of a university, and basically looked at the physical architecture in those spaces and the systems and processes in the spaces, and then guidelines on what actually makes (as she says, and this is to paraphrase very poorly), she talks about the amount of time that is spent on designing spaces for living, for us to enjoy, for us to really maximise our living space. 

That there's a dearth of research on what, what is a space of where we die? What does that look like? What does a good death look like within there. And she's continued that work into now doing her PhD, looking more at the systems of how MAiD is applied within the province through there. But yeah, that article pulled those three things together and kind of pulled us together as a means of sort of cementing a lot of those design and health interactions and intersection.

David Cummins: Yeah, it was very interesting. I even reading the article myself, I thought even though you say you've mentioned three things, each one of those things could be considered a wicked problem, where they're just so large, like education and, and training, especially with doctors and palliative care.

So, and now you've done ED, so they're all, they're all quite large problems. Do you think when, when you started on that journey that you understood exactly how big all those problems could be. Like ED in itself is huge, or do you think there was a little bit of underestimation on such a big problem because with design-thinking, my understanding is you want to say one problem, what is that real problem? Redefining that problem to find out exactly how you can create some solutions for that. 

Aiden Rowe: I'm sure there is an underestimation of the complexity and the reach of those things partly because if one fully understood sort of like, oh, this is going to be a challenge, or, it's just so daunting and as I would say to almost any student, you could spend your life on any one of those things, and still have lots to go from there.

 The section that I talked about there, one of the nice things, and one of the reasons why I wanted to be at a research intensive university was that access to different people, different ideas, different opportunities, and it was just a conversation.

I'm sure , it's finding the right people that allow those linkages of like, oh, what if we did this? , that, to be honest, to be selfish. I want to do interesting, impactful important things.

I mean, important with a small 'i' maybe. Right? But I mean, you've only got so much time and energy. How can you invest them in good ways? 

Yet at the same time, I'm also interested in, let's make this interesting and let's work from there. And so mine actually really just grew out of that opportunity. What if we took 20 design students and we took 20 healthcare students or whatever, and we got them to work in teams and push them out so they had to kind of partner up with community groups and broader healthcare things and who knows what'll come up, let's see what comes up. 

And so often, at least for me, it's sort of happened that way. There's not this great plan but this opportunity comes and then it builds on there and builds on there.

And then a great grad student or these things. So in one way, yes, all of a sudden pulling together a paper like that, it looks like, oh, this is all thought through and, and planned, and oh, this feeds into that, and that, and . I'm sure there's a bit of that, but. It's pretty behind the scenes, and it's not, at least from my point, maybe not for, for my colleagues, but yeah, you see a great opportunity and you grab it and, yeah, that's often what's happening. 

David Cummins: Yeah, I always say with our design-thinking again, I love the actual process. I love the actual not knowing what the answer is. The answers actually easy part at the end. 

It's literally almost a checklist. We can do this if we've got this much money, but get into that problem is actually the real magic and that problem solving is something that (I think not necessarily in healthcare in Australia) I think we can improve on because there's not as many people focusing on healthcare as a wicked problem.

And through design-thinking, it's very much still solution based answers as opposed to understanding what the problem is because so many people have been in the industry for so long, they think they understand the problem and they're pretty bloody close. But I think the benefit of having someone who doesn't understand the problem, it doesn't understand the industry coming in with independent eyes and eager eyes of students that actually does create a level of complexity that a lot of people hadn't seen.

Aiden Rowe: Yeah. I would like to think that's one of those opportunities, right? Of coming in and asking stupid questions, asking those things. And I think, to be honest, much of my educational approach is around that in many ways. Often I'm, as I mentioned, I think earlier, I do a lot of work with students.

Taking them to other locations or taking them, and that might even just be local. Much of our ethos here is really getting out of the studio space. We have beautiful design studios and students can work in there. But to be honest, and this is one of my critiques, often of design education is, often it's built around as I would say, sort of diluted ideas of what a design brief would be done in a studio setting set between three hours with my requirements at the end. 

And in a weird way I'm kind of judge, jury and executioner, and that's actually really, at least for me, it's actually really easy, right?

Like, I know, okay, here's the brief we're going to do, we're going to work on this. And I'm pretty sure I'm going to get 20 responses that look all like this. But just as you said, there's a pretty big frisson of excitement. And if we go outside and I'm like, actually we're going to work with this community group on this issue, and , I don't really know how this is going to go.

I know we're going to do something great out of it. I know we're going to get to a point where we're feeling pretty good and we're going to satisfy our learning requirements. But a certain amount of that is, as you said, like when we're starting. I don't know if it's a design system or design a great successful design process.

If I'm going in day one and I don't know what it's going to look like on the last day, like whatever that thing is, unless I'm really awesome or unless I'm not really doing much, versus that idea of okay, like let's really work on trying to understand the situation, the relationships, the problem.

With all the participants involved. And then we could start to see where this is going to go and, I'm going to trust that system and for good or bad trust enough of my experience or one's experience we're going to get somewhere. And that's a lot more complicated. But it's a lot more exciting.

It's a lot more real, it's a lot more impactful, I think, than just pre-packaged kind of learning opportunities through there.

David Cummins: Yeah, I totally agree. And I look forward to your new article coming out, but is there any more research coming out from the University of Alberta in reference to health?

Or what do you think your next big problem are set to try and solve? 

Aiden Rowe: Well, maybe two things. My colleagues from the one paper that you had referenced within there, the Rethinking Health Through Design. We launched the Design x Health Research Innovation Lab earlier this year, and that is meant to be a location that, and we're just building that up right now for everything from those publications to projects that we've worked on through there.

So that's kind of ticking off this year. And the systematic review that I talked about that looked at the emergency room and the relation with design that was co-written with Michelle Knox. That was really meant to be the basis for a larger research grant that is actually going to, hopefully, I mean, we'll apply for the funding to actually now then do some real research within emergency departments here within the province of Alberta in a variety of locations.

So, Edmonton, Calgary and some more rural places to assess those. And then also look at how we might actually look at implementing design to address issues within there. 

And more importantly, to try and do that obviously in the individual space, but also in a real way of hopefully looking at establishing some guidelines. Of how we might look at applying that at numerous other locations. So using that work as the baseline for a large research application later this year and further collaborating with different emergency departments. Locally, we have a hospital here at the university, but also then throughout the province as well.

David Cummins: Yeah, no, that sounds that would keep you very, very busy. 

Aiden Rowe: Yes. 

David Cummins: Thank you so much for your time. It's been a pleasure to 

talk to. 

Aiden Rowe: Wonderful. Thank you for the time. Thank you for the interest and the conversation. 

David Cummins: Cool. Thank you for your time Associate Professor Aidan Rowe. You have been listening to the Australian Health Design Council podcast series, Health Design on the Go.

If you would like to learn more about the AHDC, please connect with us on our website or LinkedIn. Thank you for listening 

David Cummins: 0:14

G'day and welcome to the AHDC podcast series, Health Design on the Go. I'm your host, David Cummins, and today we are speaking to Professor Ross Donaldson, who is an architect and recently returned back to Perth from Hong Kong. Where he was the global CEO and Chairman of Woods Bagot. Ross has travelled the world from China to USA, UK, and Australia, lecturing on the importance of climate change and how design can help reduce our carbon footprint. Currently the Chairman of Bridge 42, Bridge is also on the board of the Australian Health Sustainability Council National Task Force on the Australian Institute of Architects on Climate Change, and he's an adjunct professor at the University of WA and Curtin University where he's a lecturer and he's extremely active in the sustainability space, which is why he's the perfect person today to interview on our sustainability series. Welcome, Ross. Thank you for your time.

Ross Donaldson: 1:09

Thanks very much, David. Obviously very, very pleased to be here and to share my thoughts on what the priorities are for, for where we're at in this trajectory towards zero carbon construction industry. I have to say on a personal level, I'm finding myself refocused with the sort of messages that are coming from all sorts of sources in a fresh wave at the moment, like might have seen last week we're in November at this point of the interview, the UN report leading into the upcoming 27 in Egypt. That whilst all the talk has been on taking action out of Paris and Cop 26 to get to zero carbon by 2050, to keep the Earth's temperature increased below 1.5 degrees, we're nowhere near that trajectory. In fact, we're slipping. We're slipping behind that trajectory. We're not making any real progress. I'm in the patches of progress. And the UNs now talking about the very high likelihood that by the end of the century, the temperature will have increased by two and a half degrees. And there are other authorities and researchers in this area who believe it's three degrees and If it's going to be into that sort of territory. A lot of people, a lot of very well informed researchers and scientists talk about reaching a tipping point. People generally understand what's meant by tipping point for the earth. That'll mean tipping from the self cooling mechanism by which the earth has kept its balance since the anthropocene began. When, people started wandering around the earth. So that it'll move from a self-cooling mechanism that's kept the earth habitable into a self-heating mechanism, and nobody really understands what's going to happen when that tip happens. You know, in terms of the earth becoming a, like a hot house, just getting, you know, this constantly reinforcing its heat. And you know, if the, if the Earth's temperature continues to go much beyond that, then we're into, quite horrific potential outcomes. So for any of us, we should be seriously thinking about what we're doing and what it means for our grandchildren and their children. And in the immediate focus we have to focus on 2030. And I, I think many people will be familiar with, with the strategies that are being talked about around getting to 2030, including our own new federal government who's talking about a 45% decarbonisation of the economy by 2030. Within the construction industry people most generally talk about 50% reduction of carbon by 2030, 50%, not 45%. And that means whole-of-life carbon. That doesn't just mean operational carbon, how much energy it takes to, to make the building work. It means embodied carbon. That's all of the energy that goes into extracting and making the materials that buildings get built from. The, the industrial processes that are used to create those materials and, and components. The transport that takes them all to the site and all the energy used on site , and hopefully people are very familiar with this, what's generally referred to as 'Embodied Carbon'. So 'Operational Carbon', all the electricity and everything else you consume every day in the operation of the building and 'Embodied Carbon', everything goes into creating the building before it opens and operates. So that's whole-of-life carbon and that's what we have to measure and that's what we have to get down by 50% by 2030. It's not anywhere near good enough just to talk about operational carbon, cuz you can imagine once you start talking about extraction and industrial processes and manufacturer and transport, you can see there's a heck of a lot of carbon goes into, into the system before the building is is opened. And so that has to be decarbonised as well by the same degree otherwise. So we we're kidding ourselves. I think there's a, a well known adage that you can't manage what you don't measure. And if we're talking about us getting our heads around how we manage to decarbonise the construction industry in that timeframe, then it's absolutely fundamental that we start measuring. And we start measuring whole-of-life carbon. There are all sorts of great initiatives in all sorts of areas of, you know institutions developers local government authorities initiatives around greenhouse gases and trying to sort of lower the, you know, the climate impact in terms of how the buildings are being built and so forth and designed. But there. It's a very fragmented territory. There's, you know, it's absolutely fragmented everywhere. There's no consistent, coherent, centralised process for measuring carbon. And the whole-of-life carbon I've been talking about is measured through what's called Lifecycle Assessment (LCA), the phrases and things that people may have heard of, hopefully. So life cycle assessment measures both embodied carbon and operational carbon, and that's what we need to be all measuring, and we need to be doing it on all buildings. And once we start measuring, we can start accumulating and, and, and analysing the data of, of what is the whole-of-life carbon for a building which includes literally whole-of-life. So what's the carbon footprint that a building creates for its whole of its operational life whole-of-life carbon. So we need to be doing life cycle assessment measurement and report. When we're designing the building there's actually one local government authority in Australia. Interestingly in Western Australia, the City of Vincent, that 11 years ago implemented a process of requiring lifecycle assessments for all development approval applications. So whatever your building was in the City of Vincent, you had to submit a Lifecycle Assessment report that so that meant the designers and the client and everybody was looking at and consider. What was the, you know, the carbon footprint of this proposal? And then I think about maybe five years ago, they introduced a performance benchmark that required all of their buildings to be 50% less carbon than I think it was said against 2005 national construction code standards. There was a, Building Typology Benchmark and so they introduced the the performance benchmark after they'd been measuring and looking at the data and understanding how all the buildings we're performing. They did that for about five or six years, and then they introduced the 50% reduction. And they find that for most development approval applications, most of them are knocking it out of the park. 75% improvement is not uncommon. That's not going to be the case for every, everybody. And there will be a few people in, in that mix who will be arguing the toss about what's reasonable and what's being imposed on them. But they, they've got some very interesting you know, indicators. I think there's probably a bit of history as to why that's happening in the City of Vincent, including, but it came from the community apparently. It wasn't, there was a councillor or the you know, you know, senior executive in the system or, or the you know, the mayor, I think it came from the community came up at the councillor adopted the, process. we need that kind of leader. So one of, one of my callouts in all of the people I talk to now, and I believe me, I'm doing the rounds on this stuff is we need leadership. We need more leadership like City of Vincent. We need significant and preferably, you know, profiled institutions. Maybe a hospital or a hospital developer, or a hospital operator or someone like that saying, We are going to get onto this now. We're going to take a bite of this and we're going to start making sure that we do whole-of-life carbon reporting for every building. And we are going to get our consultant team to be analysing that and in the framework of that reporting, see where the opportunities are for driving the carbon footprint of that building project down. We need local government authorities doing it. We need universities, developers and home builders. I guess the final point I'd make about the City of Vincent, Is that they apply this requirement even to single dwelling. There's a, a terrific guy in Western Australia named Richard Haynes, who developed a, a lifecycle assessment tool called eTool. And he worked with the City of Vincent and produced what he, I think it's called Rapid LCA or something, LCA Light, something like that where you can do you know, maybe a bit rough and ready, but a good approximation of a lifecycle assessment for a house for $50. So, you know, it's, it's, there's no argument that it's a cost impulse or it's making everybody's life too complicated. In fact, I would argue it ultimately makes their life simpler because they've actually got a reporting framework that will give them indication about how they can make the improvements.

David Cummins: 9:14

Very scary to start with, but also quite uplifting to hear it towards the end. So what do we as Australians in the construction industry whether it's in health or commercial, what, what do we need to do? How can design, help improve our sustainability and carbon footprint?

Ross Donaldson: 9:32

Well, in the early stages of considering a building you know, before you've designed it the first step is to think what it's, what it's going to be built from, what's it, what's its structure. And structural engineers will tell you that. Around about 70% of the building's embodied energy is in the structure. So the first thing is to look at. Is what are we going to build this thing out of? Are we going to build outta concrete or steel or timber or, or hybrid combinations of of all of those? And then take a look at what those options indicate to us in terms of the embodied carbon that's going to be in that structure. Because it's going to be a significant number, you know, 67%, sometimes more. And that's why people are experimenting with doing timber buildings because obvious. Well, hopefully, obviously timber has a much, much lower embodied carbon than steel or concrete. Because there's just so much less energy going into the creation of the building component. You know, you, you get, get some timber out of the forest. You maybe, Gluelam it together or do something else. And then you transport it to site, which it doesn't involve anything like the, the energy that goes into concrete and steel. So, but you can't really see or understand the effect of what. Design decisions are having unless you're measuring it. That's why I keep coming back to the measurement side of it. You have to measure and it, and then it'll tell you what the, and you'll be able to see the relativities of the different structural concepts that you are considering, and then you can make an informed decision. But then there's, you know, all sorts of other components that go into the building that, you know, whether you've. What are you putting on the floor? Are you putting any kind of floor covering? Are you using paints carpets? What kind of envelope you're creating? Is it double What is the energy, impact of the different glazing systems? One of the Biggest changes or, you know, that came in through Section J of the National Construction Code is the ratio of glazing to solid in the facade and how that can change your, your energy requirements so dramatically. There's, but there's, so there's lots of different considerations like that. One of the other factors that we are seeing overseas, and we really should be looking carefully at what's happening overseas, where the leadership is you. Honestly a fair bit ahead of where we are. So in the UK for example there's, they're much more advanced in on what is called circuit economy, where you're thinking about the life cycle of materials. Demolition. Do they get reused? Do they get taken to landfill? Do they simply get sort of crunched up and into road base, which is a lower order use? And with the circular economy focus in the UK there are councils in, in London boroughs now, like Camden, for example, that will not give you a demolition permit until you've proven to them that demolition will give you a lower carbon whole-of-life carbon outcome than retaining the building and incorporating it into the existing building. So no demolition-retention, reuse of existing fabric (built fabric) is obviously a much, much better way of moving towards, typically not in every single instance, but typically much better way of moving towards a lower carbon outcome. Sometimes, you know, the building, existing building may not be configured in a way that makes it easy to reuse, and you have put so much time into you know, the repurposing of the existing fabric that it'll be more than if you demolished it. That's not very often the case. So there are lots of fundamental decisions that the, when the procurement of the development is first being considered, that can have huge impacts on the outcomes.

David Cummins: 12:56

One thing I you know, I've done my research, One thing that my research has shown, Is that there is always this resistance of people saying "someone else's problem, we don't have the money. I don't have time". it's something we have to worry about cause it's going to be four or five years away. there seems to be a lot of resistance towards this critical problem that you know, should be shared by everyone. Like, how does one overcome such resistance barriers where people think it's not there, not their problem?

Ross Donaldson: 13:24

Well, education is a factor. (this part's a slightly oblique answer to your question, David, but), when I talk to local government authorities, I say that one of the first things they need to do is get their building and planning officers trained up on life cycle assessments so they understand their stuff, they understand the implications of certain design decisions around materials and construction systems and demolition versus retention and all that kinda stuff. So that becomes part of their working knowledge, so that that's important. And that should be the case for any, any client in design group. So we, we have got a fair bit of work to do to, to get the construction industry community upskilled around life cycle assessment, understanding whole-of-life carbon. and I think, that's a very important thing. The, the other thing, you know, maybe this depends a bit on the building typology, but you know, smart boards who bring intelligent thinking and decision making around the procurement of their assets will understand if they're approaching this from the point of view of balance sheet, which they should be, irrespective of whether they're a, you know, private enterprise company or an institution these things are all assets and they all effectively sit on a balance sheet. And by 2030, and I'm, you know, we, I'm absolutely convinced the momentum is going to build on this, and it'll build up around people who are drag-liners on it. It'll move around them and move in front of them, move past them. And those who don't keep up with that momentum will find themselves what is often referred to as stranded assets. That is, they'll be sitting in 2030 or earlier with a building they've completed through what I would say incomplete and imperfect you know, design-thinking. And that building is no longer up to the standards of what is the new standard that'll be operating at that time. Now, this is particularly critical for commercial office buildings because as we know if you have a premium office building, there's a lot of benchmarks that apply. You know, Green Star has played a terrific role in you know, driving the quality up so that if you want a premium office building, it's gotta be, a decent rating. That'll also apply to buildings with poor operation energy performance, and it'll also apply to buildings that have a very poor scorecard on embodied energy because these things will become legislated. And we're already seeing signs in Europe that these things get taxed in one way or another when performance is below the requisite level. So I think people who are, you know, right today thinking about. The decisions they're going to make in relation to procuring of the next project need to be thinking in terms of the whole, of the life cycle of the building. What is the building's life cycle? Where does it sit in terms of it standing and reputation as as an appropriate building for 2030 for that. That decade, that part of the century. And quite honestly, buildings that don't measure up are going to get a reputation for it. And sometimes it'll have a very direct impact on their value. So if you got a premium office building, it's renting at premium office rates, and you get downgraded to, you know, A or B or whatever grade, then the kind of rents you can charge and the quality of the tenants you're going to get will be diminished. But I, you know, these things will apply across the board to institutional buildings as well. And, you know, reputation means a lot, to any decent organisation, doesn't it?

David Cummins: 16:47

Yeah. You're a hundred percent right because it's part of the brand and people, you get more customers with that branding and there are certain customers that wouldn't, you know, choose not to be affiliated with a certain brand that do not take it seriously. So there's a lot of benefits to, to doing it. Just before we go, like I could listen to you all day, but just, just cause we are limited in . Time. What do you think one of the take home messages, or what would you like to see happen? Certainly in the short, medium, and long term. To how we can change this cuz 2030 is not very long away. So I'm even panicking myself. So what are some of the quick wins that we can do in the world of design, in the world of construction to try and really implement this now into the future, especially for our grandchildren?

Ross Donaldson: 17:30

I'll probably go to the same point I keep being on about David, I think we have to start Measuring, and we have to start measuring now . We need to give ourselves, as long as we possibly can to be doing the measuring to get better and better understanding the implications of what the measuring is showing us. You know, because if you do a lifecycle assessment or a building, it'll give you quite precisely the kilograms of carbon per square meter of that building. For all of the components. So if it's full of concrete, it'll tell you how much, how many kilograms of carbon purse, square meter of that building comes from the concrete. It'll give you a number for the glass. It'll give you a number for the cabinet work. It'll give you a number for the tiles brickwork, whatever it is. It'll give you a precise number for each element of the building and therefore, You become so much more informed and you're capable of making a, so much more intelligent decision about how much of it you use. And you know, what are the options. You know, for example, if, if you do a building with a smaller grid, it'll always give you pretty, well always give you a lower carbon footprint. You make the grid really big to give you the flexibility. Then the carbon grows up cuz the weight of the structure goes up, is directly related to weight, really. But until you can see these things in terms of you know, measurement and reporting, it's so hard. All you, all you can do is have an opinion, but that opinion needs to be informed by the science that'll come from the measurement. So life cycle assessment, start tomorrow. Get your team used to it. Understanding it, working with it, so it becomes part of the working culture of both, both on the client procurement. And on the consultant side, and ultimately on the approval side with the authorities who are approving the building.

David Cummins: 19:17

Thank you so much for everything you've done in your career Ross. People like you that have certainly been, you know, the pioneers of sustainability. I know you've been doing it for over 20 years now, and. A lot of people have only started to talk about it. So without, you know, your brains and your constant pushing and without your understanding and knowledge and your advice I think Australia as a whole would be behind even more where we are. So thank you very much and thank you very much for your time today.

Ross Donaldson: 19:43

Very generous, David. Thanks. Pleasure. See you soon.

David Cummins: 19:46

You have been listening to the Australian Health Design Council podcast series. Health design on the go. If you would like to learn more about the AHDC, please connect with us on our website or LinkedIn. Thank you for listening.

David Cummins: 0:09

G'day and welcome to the AHDC podcast series, Health Design on the Go. I'm your host, David Cummins, and today we are speaking to Siobhan Leach, who is a group sustainability officer at Ramsay Healthcare. Siobhan has been working with Ramsay for over two years as a qualified Civil Scientist, Siobhan has continued her studies to achieve a Masters of Environmental Law and Science. Siohan now leads the way in the private healthcare sector for improving sustainability in all Ramsay Healthcare hospitals globally. As part of the Australian Health Sustainability Committee, Siobhan has been extremely enthusiastic and forthcoming with her work to help improve sustainability in healthcare around Australia and the globe. Welcome to Siobhan, thank you for your time to be here.

Siobhan Leach: 0:54

Thanks David. It's lovely to be here and talking to you about healthcare and sustainability. They're two good topics to link.

David Cummins: 1:02

Yeah, they are. So this is part of the Australian Healthcare Sustainability Series for the podcast. And I thought, what better person to ask than someone who's literally at the forefront of it. Ramsay Health has done such amazing work in the sustainability space over the last few years and won many, many awards. What's it been like to be part of that journey?

Siobhan Leach: 1:20

I think it's been a really exciting time to join a healthcare organisation, particularly with the challenges that have been going on around Covid and, and . I don't think I need to restate any of those, but it's been exciting because despite all of those challenges, Ramsay still decided to continue on the sustainability journey and, and so, As a result of that, there's so much motivation to do more in this space. It's a, it's fantastic. So I think, yeah, that is the most exciting part for me in my role.

David Cummins: 1:54

Yeah, I agree. Especially during Covid, even the NHS when they were really struggling to maintain patient numbers and beds in, in hospitals, they still made sustainability the priority. For the NHS and I believe Ramsay's done the same, you haven't actually lost focus on your sustainability goals, which has been amazing.

Siobhan Leach: 2:14

No, and it's been, really because we've been responding to what our people want, and that's really important to our board and our executive. And it's really, you know, the links between sustainability and healthcare are strong, so it makes sense that we, we do stuff more in this space.

David Cummins: 2:33

Yeah, I agree. For for those who aren't necessarily familiar with all the great work that Ramsay does in the sustainability space, do you mind. Sort of briefly telling our listeners exactly what Ramsay do, and especially in the healthcare sustainability space and what you've done in the last few years, especially some of those awards that you've won, which I've been very impressed by.

Siobhan Leach: 2:50

Yeah, I you know, Ramsay's been on the same journey as a lot of healthcare organisations and, and in the past we really, you know, totally focused on patient quality and our people. So in recent times we've expanding that to make sure we're covering what we're doing from an environmental perspective. And so that's an area that, you know, is part of our focus. So, We've over the past couple of years brought together our regional businesses and developed what we call 'Ramsay Cares', our sustainability strategy, which is about caring for people, caring for planet, caring for community. And so that was the first time for us to really Focus on sustainability. Globally, we created a global sustainability committee and we started improving our reporting. But as part of that, there have been fantastic things going on in each of our regions around sustainability. And, for example, in Australia they've been really focused on trying to swap out single use plastics. And you know, there's a commitment to swap out. 50 million pieces over by the end of the year. So that's quite ambitious. But at the same time, you know, when you do small things, it could be a small thing. In healthcare, it does make a big impact because, you know, when you aggregate all this, the material that goes through hospitals, you know, across you know, more than 500 locations globally, it does make a big difference. So that's one of the key areas we've been looking at. We've been making sure we're putting our money where our mouth is when it comes to sustainability. So we've embedded a lot of our sustainability goals into our financing. So we've did a one and a half billion dollar sustainability loan. And so, you know, when you link your financing with your sustainability targets, it really. Focuses the organisation on delivering on those targets. So that's been a really fantastic thing. And in addition to that, I guess, you know, working around some of the, the other areas we've been looking at, greening out theaters looking at anesthetic gases and, and, and reducing the impact of that. So there's a lot to do in healthcare. I'm not gonna say we're anywhere near the end of the journey. I'd still say we're at the start of that journey. But it's an exciting time for us.

David Cummins: 4:59

Yeah, I, I agree. And even though there is a long way to go, . Even though you're saying you haven't achieved all your goals yet. I would say Ramsay, especially . Are our leaders in this space, especially in the private sector space we've all worked in hospitals, officially private and public, where to even make a decision about a simple design is challenging. But you guys have got a global commitment and a global agreement, so that's very impressive. Where, where do you think that agreement came from? Was it more CEO? Was it from the ground up? Was it from the patients or the staff? Like how was that commitment made?

Siobhan Leach: 5:31

Yeah so, just before the pandemic, before my job was created, actually, they did some time talking across all our regional businesses talking to, hospital CEOs down to, hospital catering staff, trying to understand what was important to our people at Ramsay around sustainability. And so that's where 'Ramsay Cares' came from, and that's where, you know, there was. Obviously key issues around waste, climate, all those areas looking after our own people, mental health those key issues came through. So that's really where 'Ramsay Care' started. And then my role was created as, as part of that. So it's really, it's really been the executive and the board listening to our people is how I would say.

David Cummins: 6:16

Wow, that, very impressive. I know through my research in sustainability healthcare, I think the statistics are about 75 to 80% of staff always wanna be part of the solution, and they constantly see opportunity for improvement in their hospitals, but it's very hard to make the change. So it's a very clear example of the research proving that, you know, the users want to be part of that change and the executives being able to implement that change, which is very rare, but also, very humbling to to hear I suppose.

Siobhan Leach: 6:46

Yes, there's, again, there's still plenty that people wanna do out in their hospitals, but, you know, we're trying, we're doing our bit.

David Cummins: 6:54

It's very impressive, and you, you touched base before on your single use plastic removal which is very impressive. I assume that's things like water bottles, everything down to pharmaceutical medication holders. Would that be correct?

Siobhan Leach: 7:08

Yeah, so there's a range of areas they first started in, like the non-clinical space. So, you know, cuttlery, straws, medical cups for your tablets and those sorts of things. Some of the exciting. That they've been focusing on. You know, piloting across a few hospitals is the rigid containers to replace Steri wrap in our sterilisation process. So there's some really good initiatives that as they prove themselves up, hopefully we can roll out at scale. But, you know, all these things need a lot of thinking through and understanding, you know, the implications of that. But a lot of that's been led by, you know, really dedicated people on the ground, you know, CSSD, staff who've really sort of led the way and help design the solutions. So that's really exciting.

David Cummins: 7:56

And would that also include throughout the supply chain procurement where some of your suppliers have to use, specialist plastic or, It's pretty much at the moment it's contained within Ramsay.

Siobhan Leach: 8:07

Yeah. At the moment it's been more focused on the things that we can swap out or change. Like sometimes it might be totally removed, so we were giving out a lot of water bottles, that's for sure. But now we've gone back to jugs and, and that has meant we've had to put in capital and put in more washing machines and there is a labour . Issue. in. terms of more staffing, but it's been a really positive initiative. In other areas, we're really starting to work with our suppliers around, you know, we require 80, you know, by 2026, we wanna have 80% of our spend. The supplies that make up. That to have an independent sustainability assessment. And so that's really the starting point for us to have that conversation with our suppliers around, you know, a whole range of issues, you know, from modern slavery through to, you know, our carbon emissions, our scope three emissions. So there's, yeah, there, we, we are trying to put a lot of the foundations in place so that we can then get into a more mature discussion with our suppliers in this space.

David Cummins: 9:08

Yeah. Yeah, it's very impressive. You touched on before some of the resistance for change being a financial resistance where it does sometimes cost a little bit more money to create a more sustainable change. What are, what are some of the other challenges that Ramsay have faced in implementation of some of these changes?

Siobhan Leach: 9:25

Yeah, when it comes to things like waste, actually the biggest challenge is having space in your loading dock for extra bins. You know, we can put as many bins as you want and separate down to a degree, but if there's no room in the loading docks, you can't do that. So there's some sort of logistics and, and space challenges, so that's why it's really important to design these things. In. but overall, I guess it's making sure we are thinking about things from a whole-of-life cycle perspective rather than just, a short term, CapEx, assessment. That's probably the challenging part, you know, I'm sure everyone has that challenge.

David Cummins: 9:59

Yeah. agree. you also just briefly touched on design where you mentioned that loading dock, which we've all been on a loading dock that doesn't have the capacity to. You know, achieve the operational functions of waste management and procurement and deliveries. So in reference to the design of a hospital, at what point does sustainability get involved? Is it during initiation, during the early phases of design or more than later phase?

Siobhan Leach: 10:25

Well, I think we understand the need to bring it in earlier, and we are working with our development team about how best we do that. You know, I don't think we have all the solutions on that one yet. And, and it also comes down to yeah, some of these things were designed quite a while ago and they're still, you know, yet to be. You know, built or so whether you can go back into these designs and change is a challenge, but I think obviously we all recognise that the earlier you can get in with these requirements, the better.

David Cummins: 10:58

Yeah. I a hundred percent agree. A lot of research shows, even with way finding and sustainability, the sooner you get in the conversation and if you make that your KPI and your Target, the easier it is to create and design the hospital based on everyone's KPIs and everyone's goals. And especially if sustainability is a goal, whether it be the CEO or the designers or the sustainability team or the the nurses, then it's a much easier hospital to build and design around knowing that everyone's got that goal in mind.

Siobhan Leach: 11:28

Yes. And I think it's a challenge, you know, cause most of our developments would be, you know, extensions to existing facilities, you know, and, and I think if you're starting from a brand new Greenfield site, it's a different conversation as well. So I think these are the challenges that I think the whole sector faces, to be honest.

David Cummins: 11:47

Yeah, I agree. What do you think some of the best teachings are from your personal career and also your work at Ramsay? Other people could learn from?

Siobhan Leach: 11:56

I think well from my career over time, I guess for me being in sustainability, it's a pretty exciting and sustainability at the moment. But in over the past, you know, decade, you had to be pretty persistent and, and stick to your principles when there's so many. You know, positive conversations. So understanding that sometimes it's just not the right time for these initiatives. And then actually you can go back and revisit these later and, and it becomes the right time. So I think that's a big story for sustainability. At Ramsay. I think it's been, for me, it's just been a very positive experience. People really wanna help, you know, they are people who care for people and they people are very motivated to do the right thing and, and try new ideas. So I think listening to the people on the ground and making sure, you know, their voices are heard in, in how you design these solutions is really important.

David Cummins: 12:51

Knowing that the sustainability industry has been slow to start in comparison to the rest of the world, and those people in the sustainability industry have been really, really challenged over the last few years to get their voice heard. What do you think some of the improvements that other hospitals could be making right now and that they're constantly getting wrong when it especially comes to operations design rollout of new hospitals and refurb of hospitals?

Siobhan Leach: 13:18

Well, that's a very big question. David. I think an issue is is that people are used to saying no to sustainability initiatives and I think in more recent times, there's an appetite to do these things and, and bring them into projects but, everyone's mindsets might be, 'oh no, we won't do that'.... But so I think you have to challenge the status quo because I think the appetite is there now to make a change on, on these areas. So things that might not have got up 10 years ago will get up now. And I, I think that's across the board when it comes to, you know, from design of hospitals through to operations, so things that might have been tried in the past will have their, you know, their golden age now. So, so go for it.

David Cummins: 14:03

Yeah. I think also the, the people in charge now, the people, the decision makers are 10 years older than they were, you know, 10 years ago, and they're that younger generation and the more-educated generation around sustainability and there's a lot of research now that just didn't exist 20 years ago, especially in health design. Especially in health sustainability, that what was a maybe without much evidence is certainly now a definitely with a lot of evidence. And that has proven even with climate change, where there were the naysay, but the research is irrefutable now. So I do think research has had a lot to do. With that change as well. And when you've got strong governments around the world leading the way it, it makes sense for, you know, our industry to follow as.

Siobhan Leach: 14:50

Yeah, and I in every industry being data-led is really important. Being data and customer-led is super important. So you're, right now we have the data on a lot of this stuff, but there's still lots of things out there where we don't have the data. There's a lot more to do particularly. around climate, around scope re emissions, trying to, you know, move beyond estimating your scope three. So actually, you know, being able to get hard data from your suppliers is an area that will evolve as well. So, this is not, done and dusted. Now this is still an involving still lots of areas that need to be improved on.

David Cummins: 15:24

Yeah. Yeah. I hundred, a hundred percent agree. You are currently part of the Australian Health Sustainability Committee, which is a very passionate bunch of people who are leading the way in sustainability and helping reduce the carbon footprint. Within the Austral healthcare sector what was, what were some of the reasons why you chose to join the AHSC, and what would you like to achieve out of being part of the committee?

Siobhan Leach: 15:46

I think, again, being part of the change for the, in the sector, and I think there's lots of really good design ideas out there, but they need to be brought to life through, you know, Organisations like my own. So part of it for me is also learning to see what's best practice out there and what we should be aiming for. But also to make sure that sector moves together, you know, because it's hard when you are the. You know, moving on your own. So we do wanna see everyone move with us on sustainability in the healthcare sector.

David Cummins: 16:21

Yeah, I agree. The, the benefit of benefit of the ah, HSC is we've got people literally from around Australia, all experts in their field, whether it be construction, design operations, models of care development, and everyone has this common goal and common passion to try and help reduce the carbon footprint of Australian healthcare, and everyone approaches it very differently, but that common thread that we have there is certainly a good uniting front for all of us. And then as we move forward as a team, it will certainly help not only us, but also Australia, but hopefully the private and public sector as well. So what would, have you been in this industry for several years yourself? What would be some of the things that you would like to see in the next 10 to 20 years in this sector?

Siobhan Leach: 17:04

I'd really love to see, more than, you know, what is Net Zero? What is the net zero hospital? You know, there, there is a few examples out there around the world, but really starting to see that come to life generally in the market. How we do that effectively from an existing facility perspective as well. There's loads of opportunities, particularly around moving to more renewable energy in terms of helping to reduce the impact of hospitals from a scope one, scope two perspective. So there's really good opportunity there, but seeing the whole sector move on, that would be fantastic. And the consumables, I think the waste and consumables is the biggest challenge for the sector. And, and how we solve for that. But whilst maintaining high quality patient care is really, you know, it's re that is a big challenge, I think.

David Cummins: 17:58

Yeah, I, I agree. I'd love to see Australia's first carbon-neutral hospital. It's something that I think a lot of people have a vision for, and I think we're getting close, but hopefully it does happen in the next few. And finally, before we go today, what would be one of those take home messages for people in the industry and in the sector who are trying to make a change?

Siobhan Leach: 18:18

Yeah, small changes make a big difference in the sector. I would keep coming back to that. Small changes because it such a big sector. So if you can make those small changes, which you might might not be making a difference, but when you add them up across all those hospitals and all those healthcare clinics, it does make a big difference. And to, yeah, just don't let perfect be the enemy of good. Just keep going. You know? I think we just need lots of passionate people to really drive change in the sector.

David Cummins: 18:46

Very wise words, and thank you very much. Thank you so much, Jovan, for your time. It's been a pleasure talking to you.

Siobhan Leach: 18:51

Great, thank you.

David Cummins: 18:53

No worries. You have been listening to the Australian Health Design Council podcast series, Health Design on the go. If you would like to learn more about the AHDC, please connect with us on our website or LinkedIn. Thank you for listening.