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On her recent trip to Australia with Herman Miller, health design strategist Jill Joseph sat down with Habitus Editor Nicky Lobo to talk about how evidence-based design can offer concrete solutions for problems micro and macro.



September 21st, 2015

Nicky: What is evidence‑based design, and how does it differ from a traditional design approach?

Jill: Evidence‑based design is basically taking evidence, or credible research out there, and basing decisions on that research and evidence, so that you get better outcomes. For healthcare: better patient outcomes, better outcomes for your family, and better outcomes for staff.

I think that the healthcare industry has really grabbed a hold of it, because evidence makes medicine. They understand the science behind it. There’s still a lot of controversy, I think. I met an architect, in New York last week, that said, “Uh, I don’t believe in this.” I was surprised, because I think most people are pretty open to the idea. It makes a lot of sense for a designer… they have intuitive knowledge of what makes sense and what works. I think to be able to tell your clients, credibly, we have backing, we have research, we have statistics or at least have a body of knowledge that supports having patient room allows people to heal faster, that kind of thing. Especially for the science industries, for healthcare, for doctors, for nurses, and hospital owners. It makes a lot of sense to them.


Nicky: Because that’s how they operate, right?

Jill: That’s how they are.

Nicky: So how can people deny it then?

Jill: Good question. I think that there’s a thought that there’s not enough body of knowledge, because it’s a new science but evidence‑based medicine hasn’t been around…it’s been around since the ’70s. I think in the practice of medicine, 50 per cent of decisions are based on statistical knowledge, and the rest is best practices, I think by 2020 the medical industry’s hoping to get closer to 90 per cent of decisions based on actual statistical science. I think likewise, this is a new field for design, and it’s just going to take some time. It’s expensive to do research.

I think if somebody gave me an example, if there was a small sampling of people who had cancer, who took a certain drug and they did very well with it, you know it’s a small sample, it would still be valid. I think that’s the same thing we’re dealing with, with evidence‑based design. It’s just starting.


Nicky: Interesting. So you mentioned before an example of the presence of a window in a room may make a patient or will make patients heal faster. Has there been anything you’ve come across that has been surprising?

Jill: I think so. I think it’s really important to publish things that don’t work out like you think they’re going to work out. You have a hypothesis, and you think it’s going to work out in a certain way, it’s really important to publish the things that don’t work out like you think they would.

Nicky: It’s hard, I think because always with evidence there’s interpretation of evidence as well.

Jill: Right. In science you’ve got…I think this is what this architect had a problem with. He’s likening it to a petri dish, where you only have one variable change. In the actual living environment with people, there are no variables.


It’s not the same thing as doing a test in a laboratory, but you take it for what it is.

Nicky: It’s an interesting conundrum. Like black and white…

Jill: Yeah, it’s not really black and white, there’s a lot of grey area. In talking to a nurse friend of mine – that I’m very close to ‑ hearing that evidence‑based medicine is also 50 per cent based on best practice. That makes sense to me.

Nicky: What other particular skills or qualities, do you think, are required for a healthcare designer?

Jill: I think having a strong stomach, because you are dealing with hospitals. I think a designer who is very enamoured with aesthetics, high-end design, that’s not going to be a good fit for them. I always loved the practical side of design, the technical side of design.

I think you have to have an appreciation of that. A real appreciation of need to help patients, and probably had an experience yourself in a medical situation, where it makes sense to you and you can appreciate that.


Nicky: There is this focus on the function of the design, but then there are actual benefits concerns. One of my questions was how can design create health? When you are looking at a safer home, for example, there are some basic things.

In the healthcare environment, this is heightened. In your experience how can design create health?

Jill: I think the whole movement ‑ all over the world really, not just the United States ‑ it’s our movement towards wellness. We think about communities, and how communities are being designed for wellness more than they have in the past. Suburbs, where people had to get in their cars, and drive to the grocery store. The area where I live in, Washington DC, we are starting to build multi‑use spaces where there is residential and retail in the same space where people can walk and be healthier.

As far as designing for wellness, I think there are a lot of things we can do. In a key care setting we think about keeping the staff safe, so nurses have very dangerous jobs. Second to the mining industry, there have been studies that show how dangerous their jobs are, because they faced with lifting patients, walking long distances.

Standing for long periods of time, infections they are faced with, they have to be careful. I think there are a lot of things we can do to keep the staff safe, and protect them, help them to make their jobs more productive.


Nicky: How would you go about doing that?

Jill: Patient lifts are really ubiquitous in most of the United States now. There are really required in new construction nation wise. The one thing that I have been talking about around the United States is relationship with Toyota.

We utilise the manufacturing in what we do, are you familiar with that concept? We started a relationship with Toyota about 19 years ago, and acquired to our factory our assembly plants. Where we make our seeding and it’s the concept of removing waste from any system from anything you do – looking at a process and taking small steps in a very scientific way. It’s again scientific, going back to that plant, doing check at, but really looking at the process of removing waste bit by bit.

I think this idea can really save the healthcare industry, because there is so much waste in healthcare. There is about 40 per cent waste in processes. What happens with a built environment within healthcare? There is a lot of opportunity for us to improve the way a nurse finds medication easily. Finds supplies easily and quickly for the patient. Designing perks and all of that, does that make sense?


Nicky: Absolutely, it actually leads on to the next question, which was how can bad design negatively impact on health and wellbeing?

Jill: In healthcare environments if you have products that are falling apart, or are not cleanable, they are not appropriate for health care. You can’t clean them with 10 per cent bleach solution; it’s what is used across the industry. If you have a waiting area or a patient room that has products that can’t be cleaned appropriately, that can really negatively impact health.

Nicky: How do you approach this? Do you start from the really micro, and then go down to the surfaces and the cleanability/maintenance. How does it work?

Jill: I think Herman Miller has a researching development company, starts at the problem solving level. For example, the newest product line that we just came out with called “Compass” ‑ that is a modular set of components for patient room or for patient care areas ‑ really was designed at more the micro level, thinking about the problems and where the gaps are in those spaces.

I think on a smaller level, the way we develop our products for healthcare, we put a lot of thought into making them appropriate for the environment. As a designer, depending on if I’m working on a new project, a hospital from the ground up, there’s always different environments that encompass healthcare, whether it’s a pharmacy, lab, nurse station, waiting areas or public areas, like house areas.


Nicky: What can we take from healthcare design and apply to our homes, workplaces?

Jill: I think the whole issue on the challenge of aging. The ageing population across the world is something that Herman Miller is looking at. I think about it a lot. I think about how people used to age in place and different generations of people, families would live together, and they still do in certain parts of the world. They take care of their parents as they age.

I think that there’s not enough assisted‑living environments in the United States ‑ and I think other places around the world as well ‑ to take care of our aging population. So I think how can we make all environments appropriate for all different kinds of people. Really ‑ universal design, thinking about people who are either disabled, or elderly, or young. How do we look at the environment and make it very flexible and adaptable? For multi‑function, multi‑use. I think about that in a home a lot, when we’re designing our house in Washington DC. We’re designing it so that it will be appropriate for aging in place.

Nicky: Do you think, going to your point about people, social structures are different, do you think we have to go back or explore those more traditional ways of looking at ageing?

Jill: I think living together with different generations makes a lot of sense. I was just looking at our Living Office collection in the showroom over here, and the designer that was taking me through was saying that a lot of communities are having smaller residences, smaller apartments, instead of living in huge houses that we’re used to seeing. How do you live in a smaller space effectively and comfortably? I think if you look at space a different way, in a flexible way, you can do that successfully.

Nicky: Do you have a conception of Australian healthcare design? Is it any different to anywhere else?

Jill: It’s my first time here, so I’ve done some reading about it and of course, had some conversations with Caroline [Perry] and the two other children’s hospital. That was my first two; I’m going to see a couple of others while I’m here this week.

I’ve been doing international healthcare for five years. The more and more I read, I think the problems are the same everywhere, really. There are some differences that work in the Middle East. Of course, there are differences of privacy issues and cultural issues and religious issues that you have to take into account to designing those spaces.

For the most part, I think that issues of aging population, the growth and chronic disease. Diabetes, heart disease, respiratory diseases, much all over the world. Those are issues that it seems that most governments, most countries are dealing with.

How can we keep people well, so that they don’t get acutely ill, where it’s very expensive? How can we make people more responsible for their health? Some apps and things are making people more responsible. I think that newer generations, younger generations, are taking more responsibility for their health. They are more aware, probably.


Nicky: That’s good. That’s pretty much for my questions. Is there anything else you want to talk about? Any product in particular that you think is relevant?

Jill: We’ve gotten so much attention from this beautiful chair called the “Nola Chair.” It’s a patient chair, but we’ve gotten a lot of interest. In fact, I was just in Dubai, and I had multiple people coming up and talking about putting it in their homes.

I could see a product like that really going across the realms from an acute patient into all the way to the home as an ageing chair. Because it’s appropriate for people that either have had surgery or elderly and just needs support. It helps to get in and out of the chair and it’s beautifully designed. It has arms that come up, so if you had surgery, a nurse can helps you get into your seat. It has a tilt, so that when you get up, the seat actually moves up with you. The edge of the chairs allows you to get your feet back underneath you.

It’s a soft edge so that your centre of gravity… You can lift yourself up. In a home, some chairs you fall back into, like coconut chairs would not be good for an elderly person. You would not imagine, right?

Nicky: Agreed. We have one of those in our offices. Once you get in there you can’t get out.

Jill: Yeah, I love that chair. Those are the kinds of things to think about for people who are either disabled or had surgery or elderly.

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