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DAVID DEININGER: Thank you.
[APPLAUSE]
Well, thanks for having me. And it's a pleasure to be here. I am going to talk for about 30 minutes, maybe 35 minutes. And I always love to start a conversation with kind of a contextual overview. So I'm going to look at kind of the state of architecture as an industry, and then also of health care.
And then also a little bit of background on the-- Mardelle calls it a business. I mean, it is. But I'm a solo practitioner. So it's me and the dog, in the spare bedroom. So it's not quite as prestigious as it sounds. But I'll tell you a little bit about how I came to make the decision to leave a firm after 25-plus years.
And then decision making. I feel like that is kind of the crisis that not only health care is kind of confronting, but I see it as-- you see it in politics. You see it in a lot of different industries. The ability to make good decisions, I feel, is key. So I'm going to talk a little bit about that. And then also some of the tools that I use in order to make good decisions. And then some takeaways.
So the state of architecture, from my perspective, is, it's becoming a commodity. And by that I mean it's driven by fee and by fee comparison. It's kind of a pursuit to the bottom. And that's a problem. We're being seen as vendors versus partners. And when you start to become a vendor, you can see how the transaction is much more unemotional.
Firm consolidations. Every industry is consolidating, from airlines, to banking, to oil, to architectures as well. And the middle is kind of falling out. And it's going to the mega firm or a boutique firm.
Competition. Folks that never got into traditional services that architects do, contractors, engineers, other consultants, they're all kind of chipping away at what traditionally architects did. And you can see the billing inequity.
3/4 of the firms are under 10 people. And they represent only 17% of the billing. Yet, 5% of the firms are over 50. And they have almost half the billing. So you can begin to see kind of the 1% versus the 99%.
Virtual space, the idea of everything more virtually. It means less real space. So what do architects do? What contractors do if there's less brick and mortar? And then the fact that clients are expecting architects to do more, to really provide value and to link that with their business.
In health care, it's a huge industry. It's almost 20% of GDP, $3.3 trillion. So there's a lot of money involved.
It's complex. I would be adverse to even saying it's a system. It's the antisystem. Because it's iteratively changed and grown over time, with no real end game in mind. And that's what we're left with right now, just totally dysfunctional system.
Polarized. You look at Washington. What's the role of government? We don't really have a real societal national strategy there.
A lot of embedded self-interest, whether it's hospitals or physicians, insurance companies, regulators. We're not on the same page. And then, just regulatory uncertainty. You saw that with repeal and replace and what that was like.
And so much of this money is spent on either chronic disease management. Over 20% of the population has five comorbidities. So that's obesity or diabetes, COPD. Those are things that just based-- a lot of them are lifestyle choices, or bad lifestyle choices. But they need to be constantly monitored-- or end of life. So a lot of money is spent on a small percentage of the population.
There's the idea of fee for service. Traditionally, providers have gotten paid because they do stuff. So if you do enough MRIs. So that was the incentive. And we're trying to get to a fee for quality. There's competition from outside. And there's hospital consolidation.
So you can see the commonalities. A lot of consolidation happening, a lot of competition, uncertainty. And again, virtual space in the health world because of technology. Not everyone has to go to the hospital. You can do stuff from home, remotely. So less space.
So when I put my business together, 2d Planning, I think this is a great kind of overall-- and it's probably not new to you guys. This is a Japanese term, "ikigai." I don't know that I said that right. But it means "reason for being."
So it's for you, determining what is your highest and best use as a human. It's the intersection of what you love to do, what you're good at, what you can make some money at, and also what the world needs. So it's kind of that sweet spot.
I sent that Harvard Business Review on-- and a lot of the questions were on Blue Ocean Strategy. I personally think it's the best business book I've ever read. And it's probably from 2004, somewhere in there.
So it's getting a few years old. But the idea is to be able to differentiate your business in a blue ocean versus a red ocean, which is kind of sharks, and blood, and intense competition. If you can transcend competition and find a space in the market, then that's the best possible of all worlds.
And does this look familiar? Did they have a value curve in there? So let me just run through this a little bit.
In the red, that's kind of what I'm saying is the typical architectural firm master plan. I do master planning. So I'm much more at the big picture, and go around and help out hospitals kind of get their act together, and what the future is going to look like, and how do they get out of old buildings, where's the next building going to be, distribution of services, things like that.
So when you look-- whoops-- when you look at high and low, that's not a judgment. That's just relationship. So my cost-- I'm a sole practitioner. I have a lower cost. So that's how I differentiate on cost.
I do it in a much shorter, compressed time. So I go on a weekly visit. And I'm embedded on a campus for-- a hospital for a week. I tell the owner, you can come and sit right next to me for the entire week if you want or you can have anybody from your staff do it.
This is an iterative-- this is an interactive process. And by the end of the week, I'm able to give them high-level recommendations. Versus an architectural firm that may be three months, six months, nine months.
Now, I don't dive down into the details. But I can, based upon kind of where we land at the end of the week. So I do it for a much shorter time. The integration, as I said, is much higher because I'm, like, right there. I'm not back at the office doing it
And also, I take a 360 view. And by that, I used to bring consultants with me. So I have a strategic consultant. I have some financial folks, operations. And then I do the facility piece. So I feel rather than a siloed, it's much more 360. Whoop.
And then finally-- this is probably my biggest differentiator-- I'm seen as independent and unbiased because I make my money planning. Most architectural firms lose money on master planning. They want to drive the process to a building. That's where they make their money.
So owners are like, are you trying to game the system? And I'll say, no. I have no skin in the game as to what the final outcome of the master plan is. I want the right answer for you. So suddenly we're partners.
So you can think of blue ocean from a business perspective. But I also want you to think about blue ocean from a personal perspective. How do you differentiate yourself as an individual? And how do you provide the most value, for either clients or whoever you're working with.
I'm getting behind time here. So this is my value proposition. I just talked about it.
The other piece of my practice that I'm really interested in is, not only I love my clients and my projects, but I also love transferring knowledge to the next generation. And I also love research. So it's kind of this interrelationship.
There's all this knowledge. I like to manage it, share it. And then I like to think of myself having some leadership in specifics, as well. So begin to think about your place in the world a little more comprehensively.
Now, decision making. As I said, I think it's the most, kind of critical piece of what we're trying to make progress. Other questions were my background. And I shared this with your class. And you'll remember it.
But when my wife and I took my son to visit colleges, like 10 years ago, we visited Carnegie Mellon. And the person who was giving the kind of introductory, said, 60% of the jobs in 10 years have not been created yet. So it's kind of like Gretzky. You skate to the park, or where it's going to be, or whatever he says.
It's hard for you to-- my advice to you is learn how to think, learn how to arrive at solutions, be a good team player, and learn how to communicate. Most architects are visual. That's why my history degree, where I had to juggle and assimilate all this information, facts, and people, and dates, and then translate it into trends-- and being able disseminate all the information into stuff that I could then communicate. And I learned how to write, speak.
And so that's the key. You can have the greatest design solution. I can have the greatest design solution. If I can't communicate it, if I can't convince others, if I can't get everyone on the same page, it's really not worth very much.
So the biggest part of my job, I feel, is writing that-- or creating that narrative so that when I'm there for that week, by Friday everyone's on the same page. And it's kind of inevitably magic that it has come to the kind of correct solution.
But these are the big questions that we ask in any kind of strategic decision-making process. Where are we, where are we going, and how do we get there? This is just a little diagram. I know I'm not doing well on time.
So this is the other article, the biases, which I found just fascinating. Now, they're all not applicable. I find that the sunk cost is huge in hospitals. Oh, we just put money in this. We can't change it. And a lot of groupthink goes on in the room. Once the alpha in the room says something, everyone kind of clusters around that.
So do I use the checklist? I do not. I don't have the luxury of using the checklist. But just keep it in your mind that there's a reason conversations are going where they are.
The big thing about uncertainty and doubt, a lot of folks think it's kind of the same thing. But it's really not. Uncertainty is doubt. And risk is probability of loss. So, obviously, the more information you have, you can begin to transition from doubt to knowing your odds.
This is interesting because in either boom times or recession times, people have a different frame. So when things are going great, the blind spot is the details, if you're thinking big picture and everything's great. Conversely, when it's tough times, everyone dives into the tactical details. And they lose the big strategy. So balance it. You just always have to balance.
This is just-- I was lucky enough to be a Baldrige fellow a couple of years ago. Anyone heard about the Baldrige Foundation? They give probably the most prestigious quality award to health care, to education, manufacturing. And they have a fellowship program.
These were kind of their hot buttons for successful businesses. So don't be afraid to borrow, steal other people's ideas and make it part of what you do. And I had no shame whatsoever.
So I took them and began to integrate them with what I do. Then that created kind of my guiding principles. And out of that came a bunch of tools that I use. And I'd like to share some of those with you. Because do I need to be-- maybe 20 of?
SPEAKER 1: Yes.
DAVID DEININGER: Would that be good? OK.
I'm a big proponent of simplification because health care is so complicated. You can just want to crawl into bed and pull the covers up, because it is so daunting. But I feel if you're able to simplify things, if somehow there's less variables, and it becomes a little more comprehensible.
So I just wanted to share a couple of site planning fundamentals. If you can see, this is a diagrammatic site. There's always a public side of a hospital and a private side. I like to divide the site into quadrants because there's different things going on in different parts of the hospital. And you want to separate them as much as possible.
So the back of the house stuff, that's receiving. So that's the loading dock. It's usually the power plant. It's all the kind of the back of the house stuff.
There's an emergency quadrant, so the ambulances. And then people driving, loved ones screeching up to the door. So you want people to kind of have a straight line, to be able to get there.
I always like to keep a flexible zone because you never know whether that hospital may have some sort of specialty or a little bit of a different angle. Then, lastly, kind of a main door, main visitor. And that becomes where the patient-- the outpatient and the visitor comes.
And then the circulation. So you want separate circulation onto every part of the campus. There needs to be convenient parking associated with each. And lastly, getting it to threshold, into the building itself.
And then growth. My idea is to actually-- this public entrance, that can be more fixed. That's probably not going to change. It's not going to grow or get less.
So once you've made your investment in that, it's really all the clinical stuff that's going to grow. So you just want to allow an opportunity for those parts of the site to expand. Again, we're talking ideal world.
Another tool is understanding the strategic context. This is actually New London, Connecticut, for you that know the area. This is Route 95. So this is actually a geocode by zip code of all of their discharges.
So everyone who is an inpatient, this is where they originate from. Because we were looking at-- the hospital is right here. It's embedded in downtown. It's, like, 20 minutes off the highway.
And so we were looking at-- they had a major outpatient, right on the highway. So we were looking at a site that was right on the highway and seeing the potential of that site. Well, so there's the drive times for the existing hospital. So those are 15, 20, 25 minute. So by moving that to closer to the highway, we increased the 25-minute drive time by-- it was over 20%. So you can kind of see that. Toggle between those.
Another big tool that I love to use is scenario planning. And I really want to bookend the most extreme options. So obviously, one option is-- and all we should look at is the status quo. What if you did nothing?
So many clients of mine think, oh, that's the safe option, right? Many times it is not because the rest of the world is traveling along. And here you are, status quo. So you're falling that much farther behind. So it's not safe-- it's actually-- probably the most risky is to do nothing.
So this was one scenario. That's the status quo. Then we had another scenario, well, what if they bought the site and they put ambulatory services out there? What if they split the inpatient, have some of it out there? They actually weren't large enough. That was really inefficient for them.
What if they moved the entire hospital out to the new site? And then lastly, what if they merged. This was another hospital up here, their arch enemy. But what if they got together and created more of a regional strategy? So those are kind of the bookends.
So then I like to use what I term, no-regret moves. And what I mean by that is you have the options. Are there commonalities between the options? If there are, then if you go ahead with that no-regret move, technically you still have all the options in play. So it gives you a lot of flexibility.
In this case, we said, what's the no-regret move? The no-regret move is you buy the site. And then, you master plan it for kind of full build-out. So that would be the whole hospital comes over, big ambulatory program as well. It was over a hundred acres. So it could fit it.
And what we ended up doing was putting an ambulatory presence out there, with a cancer center. So it didn't preclude other stuff happening in the future. So that became kind of a no-regret move. So I love no regret moves.
This is asset distribution, mainly inpatient, outpatient. How do things kind of land within the hospital system? This is outside of Detroit, in Jackson, Michigan.
In the blue, that's all of the property the hospital owns. And I was looking at how-- and this was the neighborhood line of death. They had negotiated that with the neighborhood, that the hospital never was going to expand northward. So really, we were looking at sites that were potential acquisitions.
And also think of streets. Streets are property. You can negotiate it with your local city folks. And all of a sudden, it takes two sites separated and it brings them together. So you always want to think of that as an option as well. So really, we had really three options, east-west and south.
The way that we fell upon the final was really a growth strategy for inpatient, and then one for outpatient. Currently, these were outpatient buildings. So in the short term, we kept them there. But we really began to develop. We had a green space, a light on the street. And it became a way to kind of connect across the street.
And then, long-term everything would come from across the street. And that would allow us to expand the inpatient horizontally.
Phased implementation. Very few times are you able to have a big huge project solve everything. It's always, you put a vision out there and then you have a phased implementation to get there. And this, this is Valley Hospital. This is in our Ridgewood, New Jersey. So kind of northern Bergen County.
A lot on this site. This is a 450-bed hospital. It's on about 13 acres. All of these million-dollar homes around it. So every million-dollar home owner had their own lawyer. So this one was tremendously contentious.
They wanted their hospital. But they didn't want their hospital to do anything. So it's, again, communication I talked about. We had a lot of meetings in order to get to what we needed to do.
You recognize the quadrants? And there's some opportunity. This is the oldest building. This was the mid. And this was the building we felt was really worth building around.
So the first phase was to do a major construction here. It was new imaging. It was all new surgery. It was three floors of beds. Because there was also a height restriction of four stories in the neighborhood as well. So that, then, allowed us to offload the oldest building. And then we could kind of flip the parking.
And then the next phase was new emergency room, new intensive care, and the creation of this kind of atrium. If you think about going to the mall, walking into the atrium. And you have your anchor stores. And you can kind of see where you're going.
It was the same idea because way-finding is huge at hospitals. They usually are a real labyrinth. And you have to bring Cheerios to find your way back. So the easier you can have them, in usually a stressful situation, is certainly the best.
So then that allowed us to take that building off. This became the women and children's Hospital. This actually did not have a program. But we felt that was a placeholder for whatever is going to happen in the future.
The idea of all of the different departments in a hospital. You could list a hundred departments. And it's scary. So my idea of simplification.
I really feel you can cluster them into three buckets, one being diagnostic treatment. So that's in the green. That's essentially the emergency room. It's imaging. It's lab. It's any procedure, so surgery.
And that has a relationship. It has a relationship-- whoa. It has a relationship with beds. So that's second. So this kind of diagnostic treatment platform. Then there's the bed platform. So that's all the inpatient beds.
That's med-surg beds. It's pediatric. It's intensive care. It's NICU. It's all the beds, rehab, obstetrics. It's all the beds. And they have a relationship as well.
Observation is kind of in between. Observation is huge now because instead of having to put a patient in a bed for overnight, yet you don't want to hold them in the emergency room forever. It's kind of a in-between, where they can be observed for less than 24 hours. Then, lastly, everything else is support, in my opinion.
So it's kind of those three. When you begin to then think of the relationship of three things versus the relationship of 96 things, suddenly, OK, I can do this.
How do those lay out in kind of an idealized world? All the basement functions are support. You obviously need that receiving piece in that quadrant.
Then the main floor. You want to be entering at grade. That makes sense. And then emergency, by code, has to be at grade. So that's where the ambulances come in. That's where walk-in.
Then ED needs to be near imaging. You can see I've got observation here. That usually, but not always, is kind of controlled by the emergency room. And then there's kind of a flexible zone as well.
Then what I term the interventional platform. That's kind of taking what used to be kind of distributed all through the hospital. That's inpatient surgery, outpatient surgery, interventional radiology. It's catheterization.
If you actually just plan a kind of universal procedure room of 650 square feet, you can plug and play the technology, rather than having to rip down the walls. And then have a prep and recovery platform that's associated with it. So it's simplifying it. Did I lose my-- oh, oh. User failure. OK.
Then the idea of all of the systems, all of the engineering systems. So there's mechanical, electrical, plumbing, all sorts of things. I like to put them in kind of the cream filling of the Oreo cookie. Because what happens is if you have them in the middle, then you can feed up, you can feed down. And it's much less distance to move the air from the roof, all the way to- or the basement, all the way up. And it also makes much less space as far as the shafts. So I love to kind of have that in the middle.
And then-- whoa. And then lastly, the beds, how many there are, how many floors you need.
This is outside of Seattle, in Kirkland. And this was a very interesting kind of master plan. You can see the-- here receiving and emergency are in the same quadrant. That, as we know, is not a good thing.
So they have a major impatient and a major outpatient program. They had just built a new building. But they have left a lot of shelf space. I've never had 200,000 feet of shelf space, ever.
So they had three levels of parking under it. They had built a new emergency room. But they had shell next to it. They had a large shell, second. Three floors, they had fitted out as medical surgical beds, 30 beds a floor. And then they had three of shell.
So if you just remember what I told you, ideal, let's see if we can apply it to this. So the beds. They had ICU beds here. They had med-surg beds. They had obstetrics beds here.
They had spread out really horizontally. Many times vertically is the best connection, rather than horizontal. And they were trying to determine how many beds do we really need?
So this is where dealing with a range of values I find is really, really important. Instead of crunching all the numbers and saying, I need 186 beds, why don't you say, I need 175 to 200 beds. Because that's a much better target than-- you know, that's small.
So the way that we looked at that scenario planning, again, we looked at utilization rate, market share, and average length of stay. Those are kind of the toggles.
And that led to this, all these different combinations. And there was a 180 beds that could fit into that new tower. So we felt pretty good. OK. We've got that nailed. We've got all of these.
Now, we have an additional 42 beds. So let's make sure on the campus we have a 42-bed plan somewhere, whether it happens or not.
So here's the relationship of emergency, to surgery, to imaging. Imaging was centrally located here. But the MRI was over here. They had brought some imaging next to the new emergency room.
Surgery. There was a main surgery here. But there was interventional radiology here. There was-- oh-- this was endoscopy. And this was outpatient. So is there a way to kind of get it all coalesced?
So this is what we ended up with. The one thing they did forget, do you remember that basement from idealized, that has all of the support space? They really didn't plan for that. But, luckily, they had a floor of parking, that had enough head room. So I said, well, why don't we take that and put pharmacy and lab; central sterile, which is where they do all the instrument processing and cleaning.
And they said, that's a good idea, Dave. So then, I put imaging right next to emergency. We used that big floor for surgery. And then we fit out all of the med-surg beds.
So this one actually-- this one came up pretty well. The other piece was, this was a placeholder for another bed tower. And moving, receiving into this back quadrant. So all of a sudden, we have emergency, receiving, outpatient, inpatient. You know, really nice and clear.
And then just a little more detail. This was the lowest level. So this was the parking that I took over. And expansion, that's another thing you really need. You need to look at expansion. So here's future expansion, that could happen to the west. This was emergency. We were able to put imaging in, expansion, expansion.
This was the placeholder for that observation unit. And then this was the 18 new ORs. And there was expansion for ORs and for prep recovery.
So, kind of takeaways. You're navigating kind of very fluid and dynamic industries, all of you. And kind of find your highest and best use. Find your blue ocean. Provide value. I mean, I try to go to work every day and say how am I provide value, not only for my clients, but for the folks I work with.
Multidisciplinary approach. Get out of the silo. Think 360. That's the way of the world now. I'm working with teams that are comprised of a lot of different expertise. And clients want that. They want it of you from all different angles.
Understand your context. And then develop kind of your own personal toolkit. Because it will make it a lot easier to justify and communicate your thought process and your decisions to your clients.
So I believe that's it. I almost made it.
[APPLAUSE]
SPEAKER 1: So I'm going to read three questions from people who submitted. And then we'll open up the room for their input. So the first one-- and we went through all of these. And what we were looking for is questions that Dave and I had a chance to touch on during the course of his presentation.
So one of the first ones is from Kathleen Smith. And she's asking-- there she is.
DAVID DEININGER: Hey.
SPEAKER 1: She's asking as someone that has gone into the front [? end work of ?] health care, how do you recommend up and coming graduate students sell themselves to the market?
DAVID DEININGER: Yeah. I'd say it's not a quick thing. I got into health care totally by accident. It happened to be my first architectural job. And it happened to be a firm that specialized in health care. And I thought, never in a million years am I going to be here. And 25-plus years later, there I am.
Find what you love to do. I think in architecture, or planning, or design, there is-- many people say, well, I can't draw. You may not have to draw.
I don't know math, right. I mean, that was the big one. Because I meet all these doctors. And usually doctors say, I wanted to be an architect. But I couldn't draw. And I said, well, it's how you think. It's how you think. You can find your place in health care and architecture.
I'd say, network. Give me your information. We can stay in touch. So much of it is who you know. And just follow what you love to do. And use some blue ocean on trying to create you and how you kind of differentiate.
SPEAKER 1: Thank you. Raymond Chong? OK, Raymond. Raymond wants to know what blue ocean strategies can be applied to senior living, catering to low income class and homeless populations?
DAVID DEININGER: Right. When I talked to Mardelle's class on Wednesday about ambulatory care, the biggest piece that I think is-- you know the social determinants of health? Have you heard of that, as an idea?
It really is saying that your zip code is a lot more indicative of your life expectancy than DNA. So that is housing, food, education, transportation, access to health care. There's a lot of work being done now on, if we improve kind of the safety net for all and make it more equitable, then we're going to end up with a healthier population.
That's kind of one aspect. The thing as far as elderly care, I think it's an absolute travesty how we treat the older folks in this country. And a lot of that is society. We don't really value older people.
But I think the biggest opportunity is, we have all of these community hospitals. And they were all designed in the latter part of the last century. And the typical community hospital was all things to all people. So they had every service that that community could ever need.
That's all changing because it's just not operationally efficient. But there's a lot of facilities out there that are probably much better than the typical nursing home. And my idea is to, why don't we bring together a bunch of populations that are usually underserved?
I mean I actually was doing a little study. There is a hospital in Pawtucket, Rhode Island that went out of business. And I thought, why don't we bring elderly folks, homeless, maybe drug-dependent, maybe folks coming out of prisons, who have no place to land? Because a lot a the public kind of safety net for that is atrocious.
So blue ocean-wise, try to think of different ways to combine different populations, to create kind of economy of scale. And they'll all benefit from the interrelationship. So that's kind of the way I'm thinking about it.
SPEAKER 1: This question is from [? Mishu. ?] Not here today. I'll ask it anyway because it's probably going to be of interest to some people.
The question had to do with, have your degrees, such as an BA in architecture-- or you have actually a BA in history and a master's degree in architecture, and your executive master's-- how has that impacted your career? And what is one bit of career advice that you wish you had received when you were in college?
DAVID DEININGER: Oh, boy. I'll leave the advice when till the end.
The way that I look at my educational kind of journey was, it's really built on each other. I mentioned the history degree. Because when I was a kid, I loved history and biography, and it was either history or architecture.
And I ended up going to get a liberal arts degree, which I think is the best degree anyone can get prior to kind of going into whatever their specialty is. Because, as I said, it taught me how to analyze information and sift through it all, and communicate, and write, and things like that. Then, obviously, I had to get an architectural degree because I needed that in order to get licensed. And I made the decision to go architecture.
Now, the piece with getting an MBA was realizing that our clients are expecting more from me than just a diagram of what their site looks like. They want me to understand their business. I need to understand strategy and finances. So that's why I got the MBA, was so I could be conversant on a lot more issues.
I don't know about the advice I wish I'd had. I'm pretty happy with the circuitous route that I took, I guess.
SPEAKER 1: Right. So journey, not the destination, or something.
DAVID DEININGER: Right on.
SPEAKER 1: Brooke, is it [? Dius ?] or [? Dias? ?]
AUDIENCE: Either one. It depends. I mean for Portuguese it is Dias but you can say Dius.
SPEAKER 1: OK. So I should learn to pronounce it properly Dias, you said, right? All right. That's Brooke.
And she wants to know, as someone who has earned a LEED professional credential, do you believe that pursuing your credential only suits professionals who are interested in design and construction of new buildings? Or do you believe that any health care manager would find the knowledge useful?
Do you have LEED credentials? Good. So to answer the question. So everyone knows what LEED is? Usually you'd have to describe it. We could step in for you.
So essentially-- you can jump in and add on to it. I didn't mean to put you on the spot. So LEED is a credentialing of people, individuals, professionals, as well as buildings. And so you professionally take exams to demonstrate your knowledge of sustainable principles.
And for the buildings, they have to meet certain standards of greenness. And it might be choice of materials, how they control daylight, how much energy they expense. So on campus, you'll often see little plaques that say LEED, and they have various levels. The highest is platinum, followed by gold and then silver. And then you can have just a general status.
But to be LEED credentialed, myself, I have to take, every two years, to keep my credential going, I have to take 30 CUs every two years. That's a lot of hours, plus exams.
So I'm spending 40 hours every two years just to keep my credential going. So it's actually setting a designers' debate, do I really want to go through all this? Once I've learned the materials, is it important that I have the credential? But to get to the question. Other than designers, should other people try and achieve this credential?
DAVID DEININGER: I think, absolutely. I mean, if you're to be in the design profession in some way, shape, or form. I think the big thing behind LEED is sustainability. And that is an idea and that is a planetary goal for all of us. It's just good stuff to know.
Now, do you have to know every single detail? I mean when I went to study for the exam-- remember they gave us the book that's like that--
SPEAKER 1: It's 421 pages when I took it.
DAVID DEININGER: So I began to, like, visualize it. So I thought, OK. So they're asking me to learn this much stuff. And they're going to test me on, like, that much stuff. So how do I know where this little thing is? So luckily, I got through it.
But it's more the concepts. I wouldn't worry about the detail unless you're going to go into engineering or really gravitate more towards that. But it's a good basic knowledge to know.
SPEAKER 1: Please go ahead. You asked a question?
AUDIENCE: Yeah. I was going to ask, like, the life of a CEO in health care is like three to four years. In your master planning, have you had-- like make sure that you're planning for this CEO and maybe the next one that's coming along.
DAVID DEININGER: Yeah. Hopefully, the CEO sees themselves within that context. But I'm not dealing with just them. I'm dealing with a board usually. And the board usually has a longer vision, but not necessarily so.
I mean, you get all sorts of folks in these meetings. And some are real short term and only care about their little thing. Others are more visionary.
I think most CEOs-- I mean some want to get stuff in the ground really quickly, for their legacy. And I don't mind things going quicker. It's usually not an issue.
SPEAKER 1: But if you extend that, I would say, for example, when they started during labor, delivery, recovery in one room-- I was working with a hospital that decided to be the first one to do that, at least to separate out the operating room from the postpartum, et cetera. The staff that was part of the programming for that arrangement left after we completed the building. So there was this big--
DAVID DEININGER: I've had that, too.
SPEAKER 1: --big conflict between the new staff because they did not want to follow that model and they had not been a part of it. Now, everybody does single-room maternity care. But there was a period where it was very hard for the hospitals.
That's a legitimate concern. And so maybe there's a way to communicate the objectives as they bring new people in.
DAVID DEININGER: And certainly more cutting-- more leading edge stuff. I totally agree with you that you have to articulate this is what it means. Because, yeah, I've been halfway through the planning process. I'm a big proponent of the universal user, rather than the specific idiosyncratic user because that person could be gone. And I've had that happen.
Halfway through, Dr. X wanted this kind of bizarre thing. And the administration supported him. And then he's gone. And then the new doc comes in, what is this?
So I always try to talk with senior administration folks and say, we've got to design much more towards industry standards, with some customization because there has to be a life to this building, that's probably going to outlive many of the people that made the decisions originally.
SPEAKER 1: Please.
DAVID DEININGER: Yes.
AUDIENCE: You touched on the point of [INAUDIBLE] systems and how important that is. And I wanted to ask you more about that and whether you have any [INAUDIBLE].
DAVID DEININGER: Yeah. I think obviously the shortest distance is the best and having your destination visible. I think there's so many hospitals that have lines on the floor you follow. Or I had one client's artwork assist way-finding.
When people walk into a hospital, they're not worried about artwork as-- it's totally in my mind unrealistic. So that's where, when I looked at the one that was in New Jersey, that was a phased-- where I ended up with that atrium, where you actually could come in the front door, you could see the various elevators, where they were going. And creating that space, you could actually see the floors and how they were happening. And the person could kind of ground themselves.
But nothing better than seeing it. And then if you can't do that, then you want to make it the least circuitous process-- journey to get there. It's pretty common sense.
SPEAKER 1: We have time for one question. Go ahead.
AUDIENCE: Hi.
DAVID DEININGER: Hi.
AUDIENCE: [INAUDIBLE]
DAVID DEININGER: Yeah.
AUDIENCE: [INAUDIBLE]
DAVID DEININGER: Hard to what?
AUDIENCE: Have you [INAUDIBLE]
DAVID DEININGER: Yeah. I mean, usually the board of directors is supposed to be the liaison between the hospital and the community. So you begin to get input from the board. But most neighbors are not shy. So if they're not out picketing in front of the hospital, they make their presence known, usually complaining through board members.
And we have a lot of community meetings where we'll be unveiling a plan and getting input. So we get it, people coming up to the microphone and directly saying it. In Ridgewood, they were saying it through their lawyer. But most of them don't have their own personal lawyer. So it's pretty direct. And usually the loudest voice is heard.
SPEAKER 1: All right. Let's thank our speaker. Thank you, Dave.
[APPLAUSE]
David Deininger, healthcare facility master planning consultant at 2dplanning, gives a Health, Hospitality and Design Industry Seminar, "Multi-Disciplinary Decision Making," Feb. 23, 2018. Offered by the Cornell Institute for Healthy Futures, the seminar course (HADM/DEA 3033/6055) provides a unique opportunity for students to learn from industry leaders with proven success in the emerging industry that combines elements of hospitality and design with health, wellness, and senior living.
