We brought together our 40 Under 40 Healthcare Authority, Kari Thorsen, and Healthcare Design 2019 Rising Star, Austin Ferguson, for a conversation about healthcare design. From their early experiences as family members of patients, to their work alongside doctors and staff today, this Seattle principal and New York associate discuss inspirations, industry trends, and innovations.
Let’s start with what led you into healthcare design in the first place.
Austin Ferguson: I know from personal experience how bad healthcare spaces can be. Growing up, my dad passed away from colon cancer. It inspired me to explore how design could improve the healthcare environment for others. Once I saw the technical complexity behind it, I was even more interested. It’s like a 500-piece puzzle. There are so many pieces and layers that go into it, which makes for a really satisfying project in the end.
Kari Thorsen: We have very similar reasons. During most of my formative years, my mom was sick with cancer. She passed away when I was a sophomore in college. I started as a pre-med student at the time because I wanted to help people and make them better, but I didn’t think I would ever overcome my uneasiness around needles and blood to actually be a doctor. After I realized that I could design hospitals, I never looked back. It was this drive to create a better experience for patients, families and staff, so they can focus on getting better and not have to worry about the environment around them.
What have you learned so far from working on healthcare projects and having such personal connections to them?
Austin: Beyond the sheer amount of knowledge you gain from all the different aspects of healthcare design, it’s eye opening to see how hard it can be to challenge the status quo. There are so many players involved in each project—on the owner side, the users, donors—that it can be challenging to try something innovative or different. It forces me to look at what needs to be done behind the scenes to make a convincing case. How can we continue bringing fresh ideas even if we’ve done things a certain way for years?
Kari: I learn something new every single day. It’s why I love working in healthcare design. Each day brings a new challenge and it can’t be solved the same way as the last one. We have to push, ask questions, and show our clients different ways of thinking—that’s where new ideas come from. Another thing I’ve learned is that impact varies from project to project. It doesn’t always have to come from a really big idea in order to make a significant impact on the industry or the organization.
Austin: There’s no one-size-fits-all. I think about how many times we redesign the same 120-square-foot exam room or inpatient room—over and over again—because every institution works a different way.
Kari: That’s one thing I appreciate about ZGF. We don’t take a cookie-cutter approach to healthcare. We really try to understand the organizational needs and make the design work for them. We ask our clients, “Who are you? And how can we help create a better you?”
What do you think is the number one issue facing the healthcare design industry right now? Does this differ on the East Coast versus the West Coast?
Austin: Space is such a commodity in New York. Clients want to get as much value as possible in terms of flexibility, with very limited space.
Kari: I agree. Space is a driver, but cost is an even greater issue on the West Coast. Our clients need to support patient care at the budget they can afford. A big question for a lot of them has to do with patients continuing to get sicker. How do they balance investing in the infrastructure to support those high-acuity patients while still providing care out in the community? They’re trying to make the right decisions about where to spend their limited budgets.
Austin: Access is another important issue. I grew up in South Carolina before I arrived in New York. I’ve seen several rural and community hospitals struggling to keep up with operational costs. Some independent community hospitals are relying on larger academic centers that can afford to take over their operations. Other systems are merging together to combine resources.
Kari: Some of our larger clients are also struggling with this. Looking across Washington state, how can people on the other side of the Cascades mountain range have the same access to great care as people in the city?
Our Samaritan Healthcare client is building a replacement hospital in Moses Lake, a three-hour drive from Seattle. Their goal is to create a health and wellness hub for the community by providing amenities and teaching healthy habits in a much different way than other systems that are trying to care for the sickest patients. They plan to partner with other providers in specialty care. It’s all about coming together to support one another.
What other trends are you seeing in the industry and how are you incorporating them into your work?
Kari: Behavioral health is top of mind. There are two sides to the behavioral health need—patients and staff. Our clients recognize that it can be hard to accommodate behavioral health patients, but these patients also have nowhere else to go. It’s our job to figure out ways to support the mental health and wellness of everyone involved. Care isn’t limited for the patients, but the staff, providers, and families within these spaces too.
Austin: Technology. It’s amazing how reliant on technology healthcare delivery and institutions are now. It’s a big part of every project to make sure everything is integrated. Telehealth will continue to evolve and become a more seamless transition from the home to the hospital or clinic, but it certainly adds cost to a project.
Kari: It’s everywhere. “What’s the hospital of the future?” is the biggest question in terms of technology.
How does research inform your design?
Austin: One thing that keeps coming up, especially with new hospital towers, is benchmarking—not only against our own projects but also those seen as showcase examples in the industry. It gives us a great way to validate our design decisions and make future recommendations.
Kari: In terms of how other types of research inform our design, I did in-depth research on biophilia for the Swedish Medical Center-Ballard, Behavioral Health Unit. I studied what research already existed, the principles of biophilic design, and how we could apply them at Swedish in a way that we hadn’t before to meet the needs of behavioral health patients. For example, we incorporated movement, texture, and colors found in nature to reflect the outdoors in a figurative way. As you’re walking down the corridors, you almost feel like you’re walking through the woods, but the change in color is subtle. We also incorporated circadian lighting as a result of that research.
What inspires your work?
Austin: I wanted to experience different project types outside of healthcare when I joined ZGF. Corporate workplace projects have shown me how workplace trends can tie into healthcare. The designs are less about having your own dedicated space and more about collaborative shared space.
I’m also inspired by European healthcare design. It’s simple and refined. The buildings harken back to the pavilion hospitals of England and France. Space is more spread out because the designs are often based around the notions of light and air.
Kari: I get inspiration from patients and families—listening to what their needs are and how we can help them. Sometimes we hear something that sounds so simple, but no one ever thought about it before. When it comes to designing the physical spaces, I take a lot of inspiration from the client’s brand and mission. I look for natural elements and things within their community that reflect who they are. Here in the Pacific Northwest, we’re surrounded by so much beauty. I draw from those biophilic elements of being outside and try to bring them inside as well.
What’s your most memorable client or user experience that left an impression on you?
Austin: I appreciate the moments when I can create a personal connection with the client. One instance that left a positive impression was during a recent building tour for a post-occupancy evaluation with the building administrator at Memorial Sloan Kettering Cancer Center. We just had a great, open conversation about what an exam suite could be or what other types of spaces could be there. It felt good to know our clients are thinking through the same things.
Kari: I get so invested in our clients that I miss projects when they’re done because our team becomes a part of their culture and everyday life. One of my most impactful moments was during a current state tour for Seattle Children’s Building Care project. I’ve toured Seattle Children’s countless times because we’ve been doing some renovation work in their current operating rooms.
As I walked through this particular operating room for critical pediatric patients, there was a small stuffed animal outside of the room on the patient’s bed. The child wanted it with them until they went into surgery. I get emotional every time I think about it. It was that connection between the patient and the staff member who put so much thought and care into making sure the stuffed animal was there when they woke up.