Buildings that Heal — Spotlight: Health Q&A with Michael Murphy, MASS Design Group
At this week’s Spotlight: Health conference at the Aspen Ideas Festival, Michael Murphy of the MASS Design Group will be part of a panel called “Buildings that Heal.” Murphy is a recent recipient of a grant from the Robert Wood Johnson Foundation (RWJF) for a two-year year research initiative to investigate effective and innovative models of health care facilities in Rwanda and other Sub-Saharan African countries. The goal is to gauge the implications for community health and economic development and then disseminate the findings in order to help improve facilities in the United States.
NewPublicHealth spoke with Murphy ahead of the Spotlight: Health conference.
NewPublicHealth: Tell us about the scope of your work.
Michael Murphy: I’m an architect and designer by training, and I launched MASS Design with my partner, Alan Ricks, around designing built environments to improve health outcomes. We have been working with a number of NGOs in the global south, thinking about the way that hospitals are designed and the built environment, and seeing very specific and direct links between our built environment and the health of our individual selves and our communities. We were struck by the direct links between the two, and how un-designed those environments are when they could be so easily shifted to improve people’s health.
NPH: Where have you done your work?
Murphy: We have an office in Rwanda where we built the Butaro Hospital in Northern Rwanda, together with the healthcare nonprofit Partners in Health. That first opportunity came about after meeting with the group and seeing that they were doing a lot of their work without the help of designers and architects. We were given the opportunity to assist their infrastructure team to help them rethink hospitals. We finished Butaro Hospital in 2011 and since then have brought this model to other countries, eight of which are in Africa: Tanzania, Uganda, Gabon, Liberia, Zambia, Malawi, the Democratic Republic of the Congo, Burundi and Haiti.
So, we have quite a bit of experience thinking about the health care environments that are affecting some of the more vulnerable communities in the world, and we encountered some real insights that could actually vastly improve the way in which we think about our health care environments back at home in the United States.
NPH: What are some of those insights?
Murphy: One is that because of the resource-limited settings we were working in, we couldn’t rely on large mechanical systems to control air. So, we had to use natural ventilation—natural air flow—to encourage more cross-ventilation and air flow in the hospital environments. That would be largely impossible—if not incredibly difficult—to do in the United States because of our regulatory infrastructure here. Working on that in the African hospitals let us see that there are opportunities to reintroduce natural ventilation in U.S. hospitals, and we’ve seen a shift happening in the code and regulatory environment in the United States to reintroduce that back into U.S. hospitals after it had been largely eliminated for the last couple of decades.
I would also say we learned a lot about infection control in global hospitals, which will help us in the United States, where infection control is a massive problem. As the Affordable Care Act requires hospitals to perform better, a big piece of that will be around controlling and mitigating the transmission of infections at hospitals, and thinking about the environment—the building itself—to help reduce and mitigate those transmissions.
NPH: What are some of the projects you’ve worked on in the United States and what are some of the key things you’ve learned so far?
Murphy: We’ve worked on hospitals in northern Westchester in New York state, in Ohio and in Colorado. What we know and have learned even more specifically is that all design projects should be focused on the people using the facility and benefitting from the facility. And taking that one step further, we should be asking about what impact these designs are having on the people who use them. A new way to think about architecture is as something that is performative, something that affects people instead of something that is or something that costs money or something that is a commodity. So, transitioning architecture to a verb from a noun is a really big shift that I think is happening and is particularly potent in health care environments, though I think it applies to really any building.
NPH: How have you connected with the medical community?
Murphy: There is a very active global health environment in Boston, where our offices are. I’ve had a really amazing opportunity here in Boston being able to work with Brigham and Women’s Hospital. They’ve benefited from the facility that we built in Rwanda, and that building has attracted a lot of global health practitioners—from the Dana-Farber/Harvard Cancer Center, from Brigham and Women’s Hospital, from Massachusetts General Hospital, all here in Boston. A lot of them have trained in and experienced the facility we built in Rwanda, and that’s led to other projects, including housing for doctors that we’re building for Brigham and a new research center in Uganda that we’re building with Massachusetts General Hospital.
Because of that work, we now speak actively in the design/medical community here in the United States, including the Mayo Clinic’s Transform Symposium. I sat on the board of the Center for Health Design recently and last year won their Changemaker Award at their Healthcare Design Conference in Orlando. That’s an organization aimed at architects and designers serving the health care environment very specifically. And we are also working with the Federal Guidelines Institute, which is writing building and construction codes for the National Institutes of Health, and so we’ve been able to collaborate with some of our partners on how to rethink codes here in the United States.
NPH: Medical schools are fundamentally rethinking their curricula. Do you think medical students need medical design classes?
Murphy: I think it would be terrific for there to be design and built environment courses woven into health degrees, certainly into all public health degrees. There should be—and I think there increasingly is—more awareness of the way that cities are affecting our health and how we can use design and construction to improve our health, focusing on such things as bike lanes, walkable cities and improving pollution levels, for example.
And when we talk about buildings, we have to be aware of the system in which we’re working. There’s a typical thing that we look for when we go into hospital spaces that’s called a “work around”—such as nurses figuring out how to make something simpler by just kind of Jerry-rigging such as a tool, or making a chair more mobile or keeping a door open that’s supposed to be closed, so they can have more connectivity.
Hospital systems have become too rigid for the flexibility that’s needed to create better quality of care. The built environment can assist instead of impede quality, and design courses at the health professional schools would help nurses and doctors be more self-aware of what they’re actually already doing, which is redesigning their environments to improve quality.
Simultaneously, I think architecture and design classes should be much more integrated into thinking about health care spaces. I think we could push an agenda, not just a subset of architecture—i.e. medical architecture—but really push an agenda of looking at heavily constrained environments such as medical spaces as really a key piece of learning for how architects’ work could become better and more applicable in the environments that rely on them.
NPH: Where are you in your work on the grant from the Robert Wood Johnson Foundation?
Murphy: We just submitted our literature review. We’re doing a deep dive into the history of medical architecture in the United States and globally and are now starting to investigate specific U.S. hospitals here with key stakeholders and thought leaders. I think it will be a really fascinating investigation and should really bring some key insights into projections of where we think things will go.