 everybody and welcome to the ninth episode of Designing on the Frontlines. I would like to welcome you, our wonderful guests, our speakers, and our co-hosts from the Health Design Lab at Thomas Jefferson University Hospital and Cooper Hewitt Smithsonian Design Museum. I'm Morgan Hutchinson. Hey guys and I'm Matt Fields and we are both still emergency medicine doctors and we are joined by our team and co-sponsors from the Health Design Lab. Boncu, Rob Puglisi, Christy Shine, Mary Ellen Daly, and all of our students who are joining us. Hey students, thanks for coming and from Cooper Hewitt we have Ellen Lupton and Pam Horn. Today is Friday, July 10th and our episode will focus on designing for health of children families and communities as we face the fifth month of the pandemic. That is crazy and as many of you know COVID related deaths are rising in many states. A lot of people were saying we're just having increased infection but race but not increased deaths. Well now we're finding that those deaths are happening especially in the Sunbelt area and yesterday we're you know ending today we're again posting record numbers. With many schools reopening teachers are voicing concerns about the safety of both themselves and their students with social distancing requirements. Despite increasing numbers of COVID our emergency department is showing more patients coming in with non-COVID related complaints. Traumas and other medical concerns patients are coming in at higher volumes and we are working hard to keep everyone safe and distant. What a better time than to invite our first two speakers who will discuss their careers focusing on improving the health and wellness of children. Sunny Williams is a creator of Tiny Docs and Dr. Rhea Boyd is a pediatrician and public health expert. Our final speaker will be telling us about what buildings health and social justice have in common architect Michael Murphy of Mass Design Group. Okay but everybody you guys remember the rules everybody please put your video on we want to see your faces we want everybody to share what that's in the chat box be you are where you're from say hi check in with us again a lot of you guys have been joining us every week which has been awesome and remember we're gonna have a Q&A session at the end and so we'll Christie Shine will be monitoring that and leave us in some questions and if you've missed any of our previous episodes we have them available on healthdesignlab.com slash DOTFL. I'm pleased to say that Cooper Hewitt has agreed to help host these through their YouTube account and added some really cool graphics so it looks way more professional than what was on my YouTube account so that's really great thanks to them and we also will have one themed five minute breakout room where we'll all be split up into random groups of five and we'll get to meet each other and we'll have a prompt where we'll kind of generate some cool discussion. All right so with that I'm going to go to Rob who's going to talk to us about today's music selections. It's my turn already I can't believe it this is like what is this the ninth time number nine this episode nine today I feel like every week is cooler and cooler all right so this week every every week for those who are new I put on some music at the beginning because I love music and I think makes everything better I stumbled upon this group completely by accident this week and was immediately enchanted by their sound so I wanted to quickly show them and give them their credit give me one second see if it lets me put on my desktop here this is a group and I think this is fitting because Mass Design like a work piece here from Mass Design they've done work in the DRC this is a band out of the DRC called Fulu Miziki which literally means music from the garbage and their sound is incredible and they spread a kind of awareness about upcycling recycling and better waste management in Africa and I second I started listening to them I had to listen to every song they've ever made so check them out they're amazing and take it back to y'all. Thank you Rob so much and thank you Matt for being here post overnight after spending a whole day of research and grant writing I would like to now introduce our our colleague from afar design student designer Colleen Clark for the design fund of the week. All right happy Friday everybody I'm so excited this is back the off week really threw my sense my sense of time let me just share my screen here all right so for this week I'm kind of pulling back to some of my roots I've done previous work co-designing with adolescents which have been some of my favorite projects and so today I'm actually going to share a paper I stumbled across that is about co-design with three to five year olds which quite frankly I didn't even know was possible and astounded me completely um this project I had about 50 or so three to five year olds and I was looking at getting them involved in the design process to build an interactive application to facilitate participation during their healthcare visits particularly in primary care and outpatient settings so one thing that this paper really uh hit home which really stood or stayed with me after I read it was um emphasizing the child's perspective versus child perspective so by that they mean are you an adult trying to be a kid are you getting direct input from the child to the ultimate end user they're there so the process of the project the design process had pre-phase and then three phases in the first phase they interviewed the kids and how they actually do some of the drawings here which I'm sorry for the crappy quality I try to lift them from the paper and have them kind of illustrate different aspects of healthcare situations so things that came up were things like where their caregiver where they were and where the physician were in the room um being scared the middle one I believe is about a nurse holding a needle that injects them um you know one of the far right is about uh test tubes that have some some blood in it so the researchers are really astounded about how detail oriented these these drawings were um and so the next phase of the project after moving from this went to um went to looking at paper prototypes so on the far left you have these paper prototypes of these storyboards of the application then moving into uh the middle row here was their prototype that was the first attempt an interactive application and then then the third row is after they got the kids feedback so the kids were involved every step of the way um and so something that was really interesting was that it wasn't the kids uh age that made their feedback really valuable but how good they were with the technology which is someone who was a kid when phones were still in the wall I'm amazed at how kids are able to figure out iPads and phones and all that just intuitively so they were able to really leverage that innate knowledge um during the design process so what were the outcomes um they actually really improved the uh application in terms of its usability and the graphic design which again really um surprised me the adults were really floored at the designs they thought the kids would really gravitate towards end up not being the ones they responded to um at all and then for for the physicians in the room our healthcare professionals they actually decreased the amount of time needed during the visit because this application actually helps the whole process move along more quickly so that was a fun secondary finding uh and so the last thing I want to share is that whose perspectives might be lost as we redesign systems services and processes in response to COVID-19 so this was just a project looking at what happens when you really put the child's focus and beginning throughout the design process but this is something I've just been mulling over and came back up for me this week so back to you Moria. Thank you so much Colleen that was awesome super interesting um to see what the kids were drawing and what they responded to it's kind of like the uh you know you buy the expensive toy and then the box that it comes in is the thing that they're really interested in and it's like the user feedback that we need more of. Also glad to keep your sense of time um going this week during the COVID pandemic um I would like to now introduce our first speaker Sunny Williams. Sunny I'm very excited that you joined us today. Sunny is the co-founder and the CEO of Tiny Docs. Tiny Docs creates cartoons that focus on health topics to create materials to educate both children and their families about various surgical procedures, wellness issues and health topics and recently thank you for sharing with me. Sunny has created content that educates about COVID topics. Thank you for joining us Sunny. Thank you for having me it is an honor to join everyone today. Happy Friday and I thank you for having me and allowing you to share Tiny Docs story with you all so I'm going to share my screen. So even in this time of COVID-19 we are on a we're set fast in our mission to improve kids health and make the people smile. The story of Tiny Docs starts with myself. Sometimes you have to use the arrow key or use the slide mover. I try clicking the left mouse button. There you go. Thanks. Thanks Matt. So the story of Tiny Docs starts with myself. That adorable chubby little brown mound of rebound is myself. So when I was a kid I was an incredibly extraordinary clumsy kid. So I found myself at the ER more times than I could count and every time I went to the ER I was scared and I was very very anxious and I had physicians and healthcare professionals who took care of me and cared and were very smart and well-meaning in kinds but when they spoke to me they spoke in a language I frankly just couldn't understand and I would look to my mom and dad for some sort of help or assistance or guidance and they're college educated folks but unfortunately they weren't equipped with the language to help and understand what was going to happen next which at the end of the day I ended up awfulizing what was in my head because immediately I went to what could be the worst case scenario. So many times I would have surgery the next day and inevitably someone would hand me some sort of medical brochure. It doesn't look like this is working very well. And for a school aged kid a medical brochure unfortunately isn't the most effective tool to educate or allow anxiety. It was written in a language that I couldn't understand. It was didn't have many illustrations and so unfortunately it was a waste of resource. Now everything worked out fine for me. I grew up I'm a healthy young adult but friends and families were starting families of their own and I heard a similar narrative to when I was a child which is my doctor's very kind while meaning still there's this communication gap which creates anxiety for the kids and I'm not a parent but I'm sure there's many parents in the audience and they will tell you that they feel every inch of pain and anxiety when their child is sick or feeling ill or fearful if not tenfold. So I wondered aloud to some friends what if we turn these medical brochures into animated stories into stories that with characters that kids trusted could be entertained by and could guide them through their health journey in a language that they could understand in a medium that everyone can understand and that's when Tiny Knox was born. Tiny Knox what we do is that we create health care tunes to educate kids about health in an easy to understand language. I'm not a I don't necessarily have the creative background to put this together I recruited a team of very smart and creative folks who who are incredibly passionate about what we're building and passionate about improving kids' health and educating kids and families about how in an easy to understand language. So these are our stars Dr. Patches and their scrunch and the Meerkats they walk kids through various health procedures whether it be a surgical procedure a chronic disease general health and wellness and believe it or not now we are now we are in pandemic territory as well which I will get a little bit more I'll take a deeper dive into in a moment. So at the start of the new year with the pandemic when it just started taking hold we were stunned at the paucity of resources available to kids and families. We reached out to we have a board of children who that are material and who are part of our process from the time we start drafting scripts the time we release episodes and we just reached out and asked about what kind of questions you have what's going on at home because we really just wanted to be able to to help and address a real need that we saw what we're feeling that was really going on throughout the country. My wife is a first grade teacher so I could see firsthand as I would come in and out of the kitchen what kind of things that kids were fearful of what was going on at home. So we created so we started creating content for free because we just felt like again there was this was a real need across the country for to just answer questions like kids fears and and just help create or make some sort of sense of this new world that we live in. So we started out with creating a mindfulness episode just so kids could kind of so we could give them the tools to help them understand how to just collect their breath which is so so critical at this moment. We followed it up with a an episode on on COVID-19 just about the general outlines of what we knew at the time again just to answer elementary questions that kids had so we tried to in a very short form address the concerns and questions that they had and with them being home you know we created comics as well because the animation production timeline takes a little bit longer than creating comics and we saw that there was a significant need out there and we wanted to get resources out as quickly as possible so we created a couple comic books as well as a as our tiny activity book. Now kids just again walk them through both the science and also help them with their mental health because the parents know probably more than I do what was going on at home and how incredible and important it is to have those skills to help navigate your mental health. So as looking in the future what we're doing now is that we're going to continue to create COVID-19 related resources. We're actually partnering with a couple of school districts around the country to provide resources because it looks like a great many of them will be heading into school in the fall and so we just want to make sure that we can help kids understand and educate them how if we are if indeed we're all in this together then the critical role that they play to help us stop the spread of COVID-19. So I believe that's my time. I look forward to your questions at the end and again I thank you for having me today and I apologize for a little bit of technical difficulty. Thank you. Thank you Sunny. That was awesome and it's so great to hear from you. I know I've been looking forward to hearing from you as we've been like emailing back and forth in the last month or so. I do have a couple questions for you that I really love to know so I guess when I was in training I rotated through pediatric emergency departments and other departments like that and they have child life specialists and so one of our Scott actually just asked has this been integrated into child life departments where they actually are people in the department they kind of explain things to children and how have you had like what kind of success have you had with that? Absolutely so when we first started actually I'll admit my ignorance when I when we first started this journey I didn't actually know about the professional child life at all and they are indeed unheralded heroes in healthcare, one of them as you say. So we I should say we recruited a board an advisory board to make sure that the content that we put put out is medically sound and scientifically sound so we've actually recruited members to be part of our board to again make sure that we're delivering this content in a child-friendly manner. So to answer your question yes it has been implemented in many child life departments in children's hospitals across the U.S. and we've also made sure to include them in our production and have them as a sounding board to make sure that our content is again child-friendly and scientifically accurate and also adheres to you know how they would explain it to children as well that's very very important. They are certainly heroes and it is like 100 percent a game changer to have this kind of content and people who can relate to children and explain things in words that they understand and images they understand. I love your characters and love your slide deck and I love your cartoon so thank you very much for joining. It's pretty inspiring Matt I think I want to talk talk to some other people here. Yeah that that was very inspiring and speaking of being inspired we're going to go into breakout rooms right now where we're all going to get to meet each other and make some new friends and our prompt is about inspiration so share something whether a book a poem a piece of art or something that you've digested during this pandemic that's really inspired you helped you get through it or just something that something we should all experience ourselves so Rob can you split us up and put us into our rooms. Hey everybody I hope you all enjoyed that breakout room that was awesome I got to meet Greg and Jules a wonderful time talking to them and I hope you guys enjoyed it too. I would like to turn it over to Bonn to introduce our next speaker. Bonn is the director of the health design lab here at Jefferson. Cool happy Friday everyone I'm thrilled to introduce Dr. Rhea Boyd she is a pediatrician who practices in California she is a public health expert and she's really been a leading voice during this pandemic on addressing racial inequalities in health. Part of my breakout room I've talked about reading her work her perspectives that she's written and that's they've been very inspiring to me especially she was co-author on a perspective in New England Journal of Medicine called Stolen Breath so I highly recommend reading everything by Dr. Rhea Boyd I'll post some links to her articles in the chat room and I will hand it over to you Rhea thanks for joining thank you all for having me let me share my screen real quick okay can you all see that I got them this up perfect okay so I'm a pediatrician and Bonn said and I do a fair bit of writing and teaching about the impacts of racism on health and since this pandemic and our epidemic of police violence that struck our nation a number of people have asked me to talk about what's happening to black folks and well I could show the figures in data it honestly takes a toll on me to have to continually talk about how many black people are dying right now you know there's estimates that one in three black folks have lost someone they know personally because of this pandemic and because of police violence and so instead of going through the numbers again we're going to talk about what those numbers mean and to do that we're going to use the words of a Harvard professor and friend of mine Dr. Leah Wright Riker who on a panel I was on just a couple of weeks ago made this very poignant statement that I want us all to sit with which is that black people live without sanctuary in the United States black people live without sanctuary from the intersecting forms of violence that shorten and threaten our lives those forms of violence include state sanctioned violence like police violence but it also includes the violence of inequitable disease and the violence of inaccessible health care when we think of what that means for different groups of black folks we have to think of all of the areas for which there is no sanctuary so I'm talking about kids schools kids go to school and many are surveilled by police or subject to disciplinary practices that utilize police to arrest or suspend kids in their learning environments kids don't have sanctuary and black kids in particular from police violence when they learn in schools kids don't have sanctuary from police and state sanctioned violence when they walk down their city block we have to remember Trayvon Martin in 2012 who was killed by George Floyd who essentially weaponized the sidewalk against Trayvon because he was wearing a hoodie and eating skittles on his own city block it wasn't safe for him right we have to think about Timir Rice in a park in 2014 playing with a toy and shot by the police within seconds of their arrival on the scene we don't have sanctuary in public spaces like parks we have to think about Christian Cooper in New York in New York City Central Park right who had the police called on him by Amy Cooper just for trying to birdwatch and asking that she lease her dog like we don't have sanctuary in public spaces we don't have sanctuary in hospitals hospitals or sites where if you are incarcerated as a juvenile or a mother who's giving birth you will have your hospitalization or spend part of that time in shackles right ERs and I know some of the physicians on this call work in ERs ERs aren't sanctuaries from police violence either sitting right at the front door of most police of most ERs are armed security guards or local police officers imagine if you also have had other traumatic interactions with those officers that means your stay in that hospital is also not a sanctuary at your most vulnerable physically and emotionally you also aren't in a space that's a sanctuary from that form or risk of that form of violence and so we have to talk about what we're going to do about that so hopefully throughout some of our other breakout sessions or when we have open discussion I want people to think not just about like how racism is externally a problem but how we all participate in the maintenance of structurally racist systems that treat populations differently based on their own racial and ethnic status and what that means is we need to design to build sanctuary right we have to do that in each of our individual work we have to do it at our neighborhood level what does it mean to provide sanctuary such that public spaces are spaces that can also be freely enjoyed by black folks right so we don't risk having the police falsely called on us such that we don't even feel comfortable publicly congregating dancing in public barbecuing in public reading in our cars in public right which are all events that have brought some black folks to the end of their lives because somebody else said they felt threatened so what are we doing to make sure our our neighborhoods are safe our sanctuaries from those forms of violence what are we doing about our schools here in the Bay Area where I live um clinicians supported myself included a local resolution that actually removed police from Oakland public schools it was a huge advance police free schools provide kids sanctuary to learn without the threat that developmentally appropriate outbursts risk their arrest or their physical harm I think the bottom line is that the solutions to racism are known they're known we don't need an innovation we don't need a technical solution we know what it takes we know the laws we need and we know the impact those laws will have and as a country we have to have an honest conversation about what has kept us from implementing those solutions and frankly it is collective courage it is intellectual integrity to look with truth at what we have done wrong and how we've harmed people throughout the entire history of this nation and it's political well it's appointing people in positions of power that will actually do something about it and because we lack those things it means that we lack the tools that we need to actually pursue these solutions like our lives depend on it because the truth is that although black folks lives absolutely depend on us eradicating racism every single person's life in this country depends on it if we don't strengthen our health care system to care for black folks it's not going to care for the health care needs we have for everybody for COVID-19 if we don't strengthen our education system to educate black folks free of the violence of policing we're not going to educate everybody who wants to use the public good of education for their kids right if we don't strengthen our neighborhoods and public spaces to make it safe for everybody so that you can be outside exercise enjoy fresh air right everybody is disallowed that critical experience for their health and so I hope that this will be a setting and I hope each of you will take with you back to your settings ways that you can pursue these known solutions to racism thank you thank you so much for you I I love this principle of designing to build sanctuary as for those of us who work in hospitals and clinics I'm an emergency room doctor what are your thoughts on how we can build sanctuaries in in hospitals in a practical way one of the easiest solutions is police free hospitals we have to ensure that when our patients in our communities come in our doors there is absolutely zero risk that they will be subject to the violence of police surveillance or actual physical harm so first we have to have real conversations about removing police from our hospitals and then we have to ask how we as a healthcare system and this is what my co-authors and I were trying to argue in our new england journal peace stolen breaths that you highlighted we have to ask ourselves what is our investment in racial health inequities right it's a different question than saying like how do we actually get rid of them if we own our own investment in perpetuating them which in our article we at least give one example of that which is the health insurance market which tiers and racially segregates care in this country like healthcare systems are deeply invested in that market the AMA one of our largest physician lobbies is deeply invested in that market and it's been a major opponent to universal healthcare like we have to own that and when we own that then we have to say well then what can we do differently to divest from racial health inequities I think that's the first place maybe many healthcare organizations can start great thanks Rhea I am going to hand it over to Ellen Lupton is that right Morgan do I hand it over to you here on mute so Ellen okay that was amazing thank you so much I am excited now to introduce you to Michael Murphy he is founder of math design group in Boston he's an architect his company is one of the world's leading designers of hospital and healthcare facilities he and his colleagues are developing guidelines for redesigning public spaces after COVID including hospitals but also museums and restaurants and other places that should also be sanctuaries indeed Cooper Hewitt Museum is collaborating with Michael and math design group to organize a major exhibition called redesigning healthcare that will open in our COVID safe museum god willing in 2021 welcome Michael has been so much fun and inspiration to collaborate with you thank you thank you Ellen thanks everybody for for showing up here and joining us on Friday night thanks for inviting me I think you're ready for that inspiring talk I'm just gonna be a second to share my screen everybody see that right on excited to be here thank you again I did want to talk about the role of architecture and design and addressing health inequities but also just our daily lives of the indignity of the spaces around us so many medical professionals here on the phone are sure can speak to lots of examples of that and and that's particularly the case around the world where medical spaces are not designed to deal with the the diseases that they're faced with and that's the case we've found in facing epidemics in the past this is a center for the treatment of cholera that we worked on in Haiti after the outbreak there and the design of a purpose-built space to manage the effects of a waterborne disease and our first project I was with the partners in health working on airborne disease in Rwanda in managing outbreaks of tuberculosis and multi drug-resistant tuberculosis and how spaces there because they weren't thought about for infection control are actually incubating and cultivating disease transfer affecting especially immunocompromised patients and individuals and creating worse conditions of the epidemic within the spaces of the hospital themselves I think we knew airborne disease was something that we could design against how could we reconfigure the design of the medical facility to manage and mitigate airborne disease just by simple iterations that didn't involve large mechanical systems it got us deep into the idea that the design of a space is directly related to the outcomes of health that we might find within it and that architects and designers should be at the forefront on the front lines of trying to solve some more bigger health challenges and be kind of proximate and adjacent to medical professionals in asking those questions when the outbreak emerged of covid you know and a lot of our colleagues in the medical space reached out to us to see if there were quick infection control strategies to rearrange their spaces and so we started to develop a series of guidelines from the field working with various partners from from spaces of homeless shelters to working with folks in nursing homes or incarcerated individuals and spaces to medical spaces and just trying to assist in the most productive way to think about how these how our spaces could be reconfigured erratic you know removed and be more spatially aware of the impacts of airborne disease on on the health of the people within them colleagues from Mount Sinai and Ariadne labs research group in in Boston and in the hospital Mount Sinai Drs. John Bucavalis and Michael Todd and then Drs. Neil Shaw and Grace Galvin reached out to us during the outbreak surge in New York in mid-March at the kind of height of the of the crisis in New York City and said we have a hunch that the spaces that we're actively reconfiguring right now to manage covid are insufficiently spatially arranged and it's causing an increase in infections with the doctors and the medical professionals that are working right now as we know the kind of canary in the coal mine of this outbreak is that medical professionals are getting sick and that is an infection control problem within the spaces themselves dealing with the surges the spatial arrangement of those spaces and the kind of configurations of those wards vary all across our medical infrastructure no two are alike and sometimes very few wards and hallways and spaces are alike and so there's a vast difference in the way that protocols which had yet to be written were being implemented on the fly. Mount Sinai was really doing a heroic effort as was evident by how they're reconfiguring their space actively during the surge they repurposed people in space required strong leadership and quick decisions and three weeks operations and facilities folks were actively basically redesigning the hospital with significant modifications which would have impact on teams and and the ability to provide medicine and treat the patients that were coming in and that kind of active reconfiguration happening you know with medical professionals and staff on the fly I think had significant let's say insights into the ways in which the the space of the hospitals both working for and working against the ability to provide safe treatment and reduce infection so the doctors invited us to come and shadow their rounds during the surge to try to assist in I guess the best way to call it is increasing spatial awareness of the decisions that were being made during the middle of the outbreak to determine what was going right what potentially could improve actively while more and more patients were coming to the hospital and then to create lessons that other medical spaces across our country would face during other surges as we're seeing today and I'm just gonna I'll just walk you quickly through this one project I but can reflect more on generally afterwards and please stop me if I run over time I the first thing that we set out to do very quickly of course because we're all quarantined so we attached GoPros to a number of doctors heads and they worked with live zoom calls like this one where we were recording them we're interviewing folks as well and then we were asking for you know simple spatial awareness strategies and exercises like this one which was drawing heat maps of the spaces that we would tour with them and seeing where in those spaces they thought there were red let's say orange and green zones those were free of infection and those were full of infection and as you can see just from three clinicians and three perspectives very different ideas about what was an infectious space or a contained space was was evident and this was across of course across the entire medical facility and it's not surprising because these were wards that were actually being reconverted into COVID wards even in bed towers that were historic from the 20s which do are not really configured to deal with infectious disease outbreak double loaded corridors no isolated rooms how the space was actively being reconverted to address COVID and protect staff and patients was really was really you know both fascinating and troubling because of the limitations of this of the flexibility of the space and yet newer medical towers were were less flexible because they couldn't open windows so the older older towers like this one which had operable windows turned into the COVID units so that they could introduce negative pressure and kind of hack into the into the wards themselves and the rooms themselves to increase airflow to this patient room so fascinating challenges that each medical facility is facing we then with our team and I give all credit to Ashley Marsh and Amy Shau and John Bukavallis from our team you know spent the better part of three weeks both shadowing analyzing working with doctors and inquiring how the space could actively be changed while they were there and an amazing amount of insights emerged and both how the the space was being reconverted but also how doctors were actively being designers on the fly and I'm sure you all know that from your own experience just incredible amount of work going on but also like incredible challenges that I think will reveal some ways in which medical spaces should and will be reconfigured in in in the future we will come out of this with incredible insight and evidence that the challenges of our medical space is not being designed specifically for outbreaks and surges like we're facing is a real challenge and a real problem a couple of conclusions I just want to talk about infection control protocols have been quickly constructed but the big conclusion is that you know medical our medical facilities are not configured to adapt to the rigid adherence protocols that are required to manage the surges of epidemics or pandemics I think it's something that we should really take seriously and think about that they're you know they're designed to fill beds not to to manage surges and I think we will see more challenges related to that in terms of infections responding in situ often with insufficient amounts of equipment protected gear and clear guidelines of of how to operate doctors were working with the best knowledge that they had but not enough we saw adaptations of from floor to floor that were different unit by unit and therefore variables which are hard to manage across the entirety of the of the hospital and that simple strategies like visual aids nudges and spatial literacy could radically improve performance and understanding of where inside of a medical space we have to manage infections differently I'll just go through a few sorry so I'll run through some quick conclusions that will I think affect our the way we think about medical spaces in the future obviously hire a nurse to patient ratio minimizing patient interaction you see this in the wards we're pulling a lot of the equipment outside of the room itself so nurses didn't have to go inside the rooms a nursing station is being rethought actively and radically hallways insanely crowded throughout the medical spaces are causing all sorts of different challenges both with decontaminating cleaning as well as understanding where contamination might might be and unless so we all know the challenges of PPE and not just the existence of it or access to it the storage of it really key conclusions about a movement between spaces especially for say janitorial staff or or staff bringing food that were moving between a contaminated and uncontaminated spaces much more consistently and frequently than say nurses and doctors would be trained to do so and then things like spatial cues and spatial literacy clear and consistent protocols around thresholds aligning behavior with clear risk zones and and and kind of clear clearly identifying them on the floors and walls of the buildings themselves and then radically thinking about how the space that we're in is fostering and actively changing behavior with staff and with patients these are like clear and and sort of maybe obvious to some of you but really really fascinating and troubling to look deeply in the middle of during the surge while these spaces were being reconfigured I think we know from this that we'll be seeing a radically different type of and should be seeing a radically different type of medical infrastructure in the future and the kind of design for that not just from the ground up but the kind of reconfiguration we will learn from the hacks that we saw during these amazing moments of heroism and bravery I just will I will end there I'll end with this slide which just says that you know I think some of the conclusions we have are both self-evident but also important as we think about the spaces around us and their impact on our access to not just care but a less violent environment I think to to raise point structural violence is inherent within the very bricks and mortar of the spaces around us and so space has a vital role to play in our access to fundamental rights like like access to health I think we have to conclude once and for all that the physical environment around us shapes our behavior and our decision making and if that's the case then we need radical significantly more and radical new types of research around the behavior changing impacts of space and then finally spatial literacy how we read the space around us how we're aware of the space around us is an opportunity and a necessity for us to understand how we can reconfigure the spaces around us to open and liberate access to those very rights that we that we need and deserve so thank you very much thank you Michael that's amazing and it's been so great to follow you doing this research during this period so one of the things you point out is that graphic cues can be helpful and and I always think of signage as the thing that gets added to a building when the architecture has failed so I'd love to know an example of signage that you've seen is actually effective because I think most of it in everyday life is ignored so what what works because going to the sign company and getting some decals sure is a you know attractive solution to design problem yeah no I think that's a that's a great point and in fact I think one of the big conclusions we had if I just turn that question around a little bit is that there was such an overabundance of signage and text and you know paper printed out with taped right taped to the wall there's a there was this sort of palimpsest of letters all over every wall it was sort of impossible to navigate the hierarchy of where the information is essential and while signage might have might be put up a you know to kind of guide folks through what was really happening in the adaptation was a kind of overabundance of information and so we one of the goals that we had was to simplify what was on the walls and to clarify the hierarchy of what was necessary and essential and that meant taping on floors taping on walls like removing some of the kind of taped up posted simple like printed signs and making it really clear what they should be reading and it was part of the problem why why some of the staff didn't know they might be entering a contaminated zone and they need to be you know dawning and doffing for example and that I think signing signage was the problem amazing do I have time for one more question more gonna do I have to stop one more so far one more okay so you mentioned spatial literacy can you share with our audience like one great tip for becoming more literate and reading space yeah I think I think we often find ourselves in a space of frustration when we encounter the limitations of space and you know we say like this isn't working for us and this isn't clearly the designers were idiots or there was some big problem here and they didn't think about the the totality of lived experiences that might encounter the space and while some of that may very well be true I think it's often it's been useful for me to say to ask why was the space designed the way it was at like what's what's solute solution was it seeking at its time and how can we understand if that is still a problem in the same configuration and so do we adapt the space to address the evolution of that problem or do we have to reconfigure the space altogether and so seeking out the problem solving of the past can also often help us find solutions to the future and I think that's the case with airflow I mean buildings are you know older buildings are better for natural airflow than newer buildings that are reliant on mechanical systems you know so there's this kind of broken problem that we are fixing we're not really fully fixing if we don't think about the way that space is breathed all the time so great thank you I think we got to pass it back to Morgan now that was amazing Michael thank you so much thank you so much Michael super inspiring and we are very lucky to have you and thank you Rhea thank you Sunny I will turn it over to my colleague in the emergency department and in the health design lab Christy Shine so we can ask some of your questions the audience questions to our speakers great thanks Morgan amazing talks everyone super excited to be able to ask some of these questions from the audience so one question that was asked going back to Dr. Boyd's presentation Dr. Boyd you mentioned you talked about inequitable disease and inaccessible healthcare as a form of violence that actually threatens black lives and I'm wondering could you give us an example of a person or an organization that has managed to successfully transform themselves or their organization to build the type of sanctuary that you speak of sorry I'm thinking as you're talking um let me think of an example at a scale I don't know if I can pull a perfect example and I'll even maybe push back on the idea I get this question a lot like where's the best practice who's doing it well these solutions are probably going to be tailored really uniquely just like any design to the local population it serves but one of the major overarching forms of structural racism that shape the distribution of disease and healthcare services in this country is racial segregation like if we did something about residential segregation which also shapes educational segregation which then shapes right the future economic mobility of communities by race and gender in this country if we did something to dismantle residential segregation I think we would see more equitable outcomes the question is how can healthcare systems participate one example would be for healthcare systems to one consider being for consider being tax eligible so having healthcare systems be non-profits often means that they have business models where their physicians will be hired by a for-profit part of the business model and the hospital will be non-profit but if a hospital which is usually the primary employer in your area is also a non-profit all of its profits aren't going into local infrastructure and then folks who move in to work in that hospital system because we have a segregated workforce as well they displace the local work the local community members who might otherwise live closely so hospitals are also major sources of gentrification in neighborhoods so one thing we could do is diversify our workforce hire people who work locally and consider paying taxes so that we also support the infrastructure that exists outside of our walls it's part of why many hospitals and academic centers exist in neighborhoods that are otherwise deeply impoverished thank you Rand those are some great suggestions for all of us um question going back to Sunny um this is from Michael Hode one of our audience members he'd like to know how do you go about distributing the educational the educational materials that you have so we make it available it's kind of like Netflix but for healthcare so our library we make it available to hospital networks smaller pediatric offices and fairly qualified health clinics and they can make it accessible anyway they want whether it's through the waiting room or whether it's through the virtual patient waiting rooms we found that actually because of the the healthcare settings are very intimidating for patients of course and so a lot of times doctors will give instructions and because the environment to go back to space is so intimidating that a lot of times it goes in one ear not the other so what we like to do with tiny dots is make it available where it's a more comfortable setting it fosters the conversation and you can walk back into the healthcare institution a lot more confident and a lot more knowledgeable and a lot more sure about what's going to happen next with regards to the child's health thank you and morgan do we have time for just one more one more okay uh and just going back finally to michael yajima asks do you have a sense for what um providers and healthcare physicians nurses apps what do they want to go back to in terms of space after the pandemic i'm sure a space that doesn't make them sicker when they go to work is probably one crucial thing that we could be fighting for as a an assumption that we should have spaces that protect those that are working within them i think it's it's made evident that so many healthcare workers are getting sick by doing their job um that the built environment that we have around us is broken it is fundamentally serving sometimes the wrong needs it's not seriously considering the totality of issues around not just epidemic disease but general airflow i mean we think that the fact that we accept what is it 30 to 50 thousand deaths a year from the from the flu anyway that is related to being inside of buildings where we're getting contaminated and now with you know proof that aerosols a lot aerosolization is happening with covet it is being in buildings that is making us sicker so we are all now i think facing a kind of spatial awakening a kind of spatial awareness that the buildings around us make us sicker and so we have to i think build a kind of movement and active uh an act instead of an active movement in push to radically demand that the spaces that we inhabit are protecting us are considerate of the diseases and infections that are around us and and also are serving us uh the the full totality of ourselves with spaces of dignity those are great points thanks thank you to all of our speakers today thank you so much i really appreciate everybody sticking around for a few extra minutes we are just about ready to conclude this has been an incredible week and given me so much to think about and taught me so much and i'm just very inspired next week we have rachel smith dr zynga harrison and dr sesha doku for our episode on 717 and we hope to see you guys all there thank you so much to our speakers this week thank you sonny williams thank you dr rhea void and thank you michael murphy thank you guys so much and thanks to everybody who joined in the discussion thank you