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The Voice of Healthcare - Episode 10

Co-hosts: Dr. Matt Cybulsky (Principal, Ionia) and Bradley Metrock (CEO, Score Publishing)

Guest: Tama Duffy Day, Health and Wellness Practice Leader, Gensler.

Duration: 25 minutes, 13 seconds

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Bradley Metrock: [00:00:15] Hi and welcome back to The Voice of Healthcare - Episode 10, for April 2018. My name is Bradley Metrock - I'm CEO of a company called Score Publishing, based here in Nashville, Tennessee.


Bradley Metrock: [00:00:30] I'm joined by my co-host, Dr. Matt Cybulsky. Matt, say hello!


Dr. Matt Cybulsky: [00:00:35] Hello America, and the world. Hello Bradley!


Bradley Metrock: [00:00:38] Matt, it's been a while since our last episode. Thank you for joining us This is going to be fun.


Dr. Matt Cybulsky: [00:00:45] I'm always glad to be here. I'm really excited about who we have on today - a really fun vector to talk about.


Bradley Metrock: [00:00:50] Yeah, this is great. Our guest today is Tama Duffy Day. Tama, say hello!


Tama Duffy Day: [00:00:57] Hi Matt. Hi Brad.


Bradley Metrock: [00:00:59] Tama, thank you for joining us today. We're really honored to have you. You are a Principal and Health and Wellness Practice Leader for Gensler. Tell us about Gensler, and tell us about what you do.


Tama Duffy Day: [00:01:15] I'd be happy to. Gensler is a global design firm, and we are involved in designing architecture and interior design, but also brand planning and urban design and product design. And we work with clients large and small, for profit, not for profit...and I have a fascinating, wonderful position at Gensler where I lead our health and wellness practice and really seek to deliver and design and innovate in the field of healthcare.


Bradley Metrock: [00:01:48] Very cool. So one of the things that you are an expert in is something called generative space. As someone who is not involved, from a professional standpoint, in the healthcare industry - other than co-moderating this show - I find this concept extremely interesting that there is such a thing as generative space, that there are people actively thinking about this, such as yourself. Tell us: what is generative space? And how are hospitals, or different healthcare operations, thinking about generative space?


Tama Duffy Day: [00:02:23] Yes...generative space, I would agree, it's a fascinating concept of design. I've been working with Dr. Wayne Ruga, who lives in England, on this topic for about 15 years. And in its simplest form, generative space is really a place to flourish. And by that, we mean a place both physical and social that improves health, healthcare, and the quality of life for those who engage. And its purpose is really to increase performance and effectiveness, and to really create lasting relationships.


Tama Duffy Day: [00:02:59] One example of my first engagement in generative space was working with a client called the Arlington Free Clinic, and we designed a new clinic for them that was opened in 2009. And Nancy Sanger Pallesen, who was the Chief Executive Officer at the time, really worked closely with me in trying to interpret and understand literally what generative space means. And for them we were really able to engage their staff, their shareholders, their volunteers, and their patients to design a space that really encouraged health and it encouraged proper interaction. And over the years, in pre and post occupancy evaluations, we've learned that they've been able to see more patients - that they've increased the number of patients they literally can see because of the effectiveness and organization of the clinic. But they've also increased the number of volunteers over the past number of years, because the place really supports health. And in one of our visioning sessions with Nancy, as we were starting the project, we said "well, when we're done with this project, you we would know we were successful?" And she said, "We want people to walk in and say 'Wow!'".


Tama Duffy Day: [00:04:13] And ironically, it actually happened: we were standing there, close to opening, and one of the patients opened the door for another patient that was coming in, and unprompted, he said, "Welcome to the Arlington Free Clinic. This is a place for health." And we just looked at each other and smiled, because you know when others interpret and see and sense that the place has been designed successfully, you know it means that you have accomplished some of your goals. And we're actually working with them now on a minor renovation and going back and testing the hypotheses of how the design was created, and expanding some of their service to include dental care, which wasn't a part of the original project.


Bradley Metrock: [00:05:01] How, from your standpoint, do you look to incorporate technology, such as in the case of VoiceFirst.FM, voice-first technologies such as voice assistants like Alexa or Google Assistant, or possibly some privately designed stuff, or maybe even taking a step further with machine learning or AI. You know, obviously, you're designing aesthetics here. You're designing the environment. And inherent in that design process is going to be thinking about how technology can augment what you're doing. Share with us a little bit about how you, from your standpoint, your experience, your background...look to incorporate technology within this generative space concept.


Tama Duffy Day: [00:05:51] Well generative space is a lot about empathy as well. You know so there's this high tech and you know high touch part of what we do that I think integrate well. And technology in healthcare is a constantly evolving element that does require both design engagement as well as I think philosophical engagement. And as I'm sure you're well aware that movement into telemedicine and remote applications of conversing with patients and providers is really key. And we've been working with patients and providers to understand you know what does that mean. How do you keep an interaction alive? You know much like we're doing today, we're talking. I don't really see you I'm talking on a microphone and yet I have a connection to you because I can sense it in some way, either it's the tone of your voice, and so really having clarity in the communication, acoustics, sound, lighting and telemedicine are really critical. And unfortunately healthcare tends to be one of the kind of slower moving industries when we move into new technologies. But it is happening. And you know we see in every day in our work with them.


Dr. Matt Cybulsky: [00:07:05] You're a highly decorated designer, so this is something that obviously you're passionate about. You know what I do know about your work is the incorporation of emotion. You mentioned a moment ago about hearing us, about sensing us. Martha Nussbaum, who is one of my all-time favorite philosophers and public intellectuals, has this wonderful quote and she says "emotions are not just the fuel that powers the psychological mechanism of reasoning creatures. They are parts of complex messy creatures of reasoning themselves." That being the case, I see that you value the intelligence that emotions offer humans. And it seems if you're trying to incorporate that into your design. It was heartening for me to hear you say that somebody addressed the building that you guys had designed as a place of health instead of a place of illness. Could you talk a little bit more about how emotions are incorporated into your design philosophy, especially as it relates to healthcare?


Tama Duffy Day: [00:08:13] Sure. You touched on a lot of really important parts and you know if you think of that part of one's life when you're fragile and you know susceptible to perhaps more emotion, I can't think of a higher topic than health whether you're giving birth to a baby, you now some of the most emotional highs, or whether you're sharing the last moments of breath with a loved one, perhaps one of the most emotional lows, that health and healthcare really touches all of us at an emotional level, a very powerful emotional level. And you know the entire existence I think of my career has really been focused on watching and listening and observing, not only others, but my own interaction with healthcare providers and understanding how place makes a difference in that interaction.


Tama Duffy Day: [00:09:07] And going back to generative space for a moment, the idea of that is really that the provider and the patient are equals. And I'm just going to pause on that for a second because in my parents' generation it wasn't really the case. The provider gave them directions and they kind of followed it. They didn't question them. I would sit with my aging parents in their conversations with their physicians, and they nodded their heads, and they shook their head, and they listened, and they never really asked questions or had an opinion about doing something differently. And I think that that isn't really the case for healthcare anymore. I think that we investigate, we research, we ask others their opinion, and this is a really critical part of designing places, but also designing the interaction between care providers and patients.


Dr. Matt Cybulsky: [00:10:02] Yeah I couldn't agree more with you. In my interactions though, what I found is that the authority gradient that exists in the provider side, as well as the patient side, you know as far as their perspective, still exists to a large degree. Like you, I've also had experiences where the value of connecting emotionally, like integrating with a patient base for a provider, has resulted in healthier outcomes, sustained outcomes. Do you think that with your design, or with this sort of momentum towards a quality of care and integration emotionally of care, that will have more advances in how we decided to levy healthcare across the United States as a full physical design, or maybe how you're incorporating design perspectives to your clients, can help move that needle a little bit towards some equanimity and quality in the care?


Tama Duffy Day: [00:11:04] That's a huge topic and a huge question. So I'm going suggest answering that in two ways. One at a micro level; So we've been involved with testing the validity of an exam room with the Rush University Medical Center in Chicago and outlining and understanding you know over 80 attributes of an exam room design that impacts the providers ability to provide the care that they need to give during that interaction and exam room, but also really focused on the patient, the consumer of healthcare and understanding their perception. And one of the important elements of the design of something as simple as an exam room was creating a place for the interaction with the patient and the provider in a specific way so that they can look at each other, share the medical records together, and design a workstation that the provider could function and make notes, but also that the patient could interact with them at that same kind of intimate space. And that was an important element of the design of that room. So at a micro level something as simple as that impacts communication, which impacts your understanding of what the provider is sharing with you about their belief about your health?


Tama Duffy Day: [00:12:19] And then at the macro scale we design cities. So imagine you know the design of a city in such a way that it supports walk-in, that it supports being out in nature. That this places in spaces that we design in a city integrate transportation, and integrate retail, and health, and entertainment, and sports, in such a manner that we support longevity in how we live our lives.


Dr. Matt Cybulsky: [00:12:48] Yeah I think there's no question that the quality of life is its own medicine, the food you're eating, the lack of stress, reduction in stress in your day to day, designing spaces that allow people to be the social animals they are in a healthy manner. I couldn't agree with that more. We're going to take a shift for a second here and kind of put a little bit more of your future lenses on you. Two questions, where is the design of healthcare headed? I love the momentum you've got thinking about human emotions and integration into the space. But beyond that, where are we headed? What's it going to look like later? And then the second question is, and this is on a lot of people's minds, is women in design. Is there a movement towards feminine sort of philosophies when we look at designing spaces as a benefit to all patients? And I mean feminism in the sense like the classical philosophical sense of feminism right? So like nurturing, justice, fairness, those kinds of terms not necessarily gender feminists.


Tama Duffy Day: [00:14:01] In terms of what does the future look like. So we have think tanks in our in our firm where we bring in thought leaders from around the industry to imagine what their perception of the future is, and we've had several of these in the last few months that have been really focusing on experience. And you know I described in it what I would find as an amazing interaction with a provider that I would walk into a room and the entire wall of that space would have my medical information on it. You know my genetic data, my last blood results, information about height and weight, and anything else that has been going on, and I had an opportunity to touch the screen and move things around and look at different parts of my body and body systems and understand like what's been happening in real time. But also looking historically and into the future and that I could interact with all of this, literally somehow digitally, and through technology, and that it wouldn't really matter to me if the provider was in the room or not. And I guess if I really thought about this, maybe I'm doing this in my own home and I'm able to look at all of this.


Tama Duffy Day: [00:15:12] But I think a part of the future is about access. We've talked a lot about big data. What does big data mean? How do we support it? You know we understand you know there are some architectural and engineering components of data, because you do need places for it to reside and to ensure this 24/7 operability. So those are pieces architecturally that we're focused on, but I think that technology will appear in a variety of ways in robots. We're going to have more access to health in our homes. And I really think it's going to you know continue to turn our industry upside down, which I love because we are a part of being disruptors in that marketplace.


Tama Duffy Day: [00:15:55] And in terms of feminism, well I'm sure you know this, but you know healthcare decisions are made 90 percent by women. If you look around you and think about how that happened, some of the transformation of healthcare happened in the labor, delivery and recovery area. Hospitals began to market if you will their LDR suites, their maternity wards, to healthy women because women giving birth are typically healthy and women would shop for where they would go to give birth to their child. And through that, the health system learned that if you got a woman, and her child, and their family into the health system she tended to stay in that health system for the entire length of that family's existence in that location. So it's a very powerful connection between birth and connecting with that provider for the rest of the care. Additionally, women tend to make decisions for all family members, not only their immediate family, but in-laws, grandparents, and children.


Tama Duffy Day: [00:16:58] So women have a very powerful piece in the future of health and in the current state of health. And in Joseph Conklin's book called The Longevity Economy, there's a whole chapter on the future as female. And he believes that we've yet to uncover all the possibilities of women's thought and leadership in design and innovation, in healthcare specifically. And for me it was a very optimistic view of the future and our place in future and creating that future place.


Bradley Metrock: [00:17:30] Tama I've got a question for you to close, and it's going to take it a little bit different of a direction. Back in January you reposted something to your LinkedIn profile that was originally posted on Gensler's site called Sound Health - How Noise Can Inspire Healing. So I'm a classically trained pianist since age 4. I'm a huge music fan and I'm fascinated by the idea of sound therapy or music therapy, just the concept that some which away you know music is capable of healing us. And I believe that. I don't need to see any sort of data to know that that's true.


Bradley Metrock: [00:18:17] And I found this article that you reposted, that was posted to Gensler's site at first, extremely interesting, and the project itself is very interesting that y'all did with the Sibley Innovation Hub and Yoko. I want to ask you, you know there are a couple of things going on here. Part of what we talk about regularly with VoiceFirst.FM is all the different ways that these smart speakers and the fact that we're getting these audio devices into people's homes in a way that no one ever thought was going to be happening and these voice assistants and the rise of voice-first technology. Sound is becoming much more important and much more sort of omnipresent, and you know Matt and I have talked on this show before about how senior citizens are helped, just to mention one example of many, by the fact that they cannot be as isolated and not be as depressed for being isolated by just simply being able to talk to one of these voice systems, have a conversation with Alexa or Google Assistant, and it brightens their day a little bit. Just that sound, that interaction of sound, of hearing this voice talking to them makes a difference. I just wanted to close by asking you about this project that you did and what you have learned about how sound can heal us and some of the takeaways from what you all did here.


Tama Duffy Day: [00:19:50] Yeah I love that you did some homework, that's fantastic and thank you for reading that. It's a three part blog series called Sound Health and it really outlines a journey that we took and have been on with Yoko Sen, a sound alchemist, and as you mentioned, working with the Johns Hopkins Sibley Innovation Hub. We were fortunate enough to be able to begin this journey when Yoko uncovered the fact that providers in some of the intensive care units at Sibley were in need of or in desire of a place to escape. And that came through rigorous research that Yoko uncovered through Sibley's Innovation Hub on the need for wellness and well-being and emotional restoration. And you know emotion is a really important part of how we care, and provide care, and if you're a provider you can only imagine, or I can only imagine, if I put my head in pretending to be a nurse or a provider on an intensive care unit where people are very sick and they you know not always make it through their journey and do pass on.


Tama Duffy Day: [00:21:04] And so we created with Yoko a tranquility room where the providers can find a moment, sometimes it's even as little as 10 seconds, to step away and recover if you will emotionally from stress or trauma that may have happened or gone on in their shift while working in providing care. And it's a really fascinating project that began with not only the understanding of sound, but of looking at all the senses and how we could create a space that provided a calming sound that Yoko designed. It had art, it had color and shape and form. There is a aroma therapy going on and it's really looking at a space that could nourish, in just a few moments, or just even a few seconds. or minutes, a care provider and provide some tranquility in their space.


Tama Duffy Day: [00:21:56] You're absolutely right, that as we age, isolation and engagement is a really critical piece. I'm on the board of Capitol Hill Village, which is an organization on Capitol Hill here in Washington D.C. that's really focused on keeping seniors and the elderly in our communities in their homes as long as possible. And the social aspect of that is one of the critical pieces of engaging. And I guess I'll take this right back to generative space which was the beginning of our conversation, because it's about both the space and physical and social, and the social aspect of our lives is a very critical piece of us being healthy.


Tama Duffy Day: [00:22:38] And so designing for a social space, as we spoke about the future thinking and designing not only the exam room but a city, as we design social spaces it connects us in meaningful ways for longevity and for health and for wellbeing in like every aspect of that. Those that want to read more about sound health can log on to the blog series that we wrote about that article and read more about Yoko and the great work that she's doing.


Bradley Metrock: [00:23:08] And we're going to link to that as well in the show notes. A couple points before we close, just a couple of promotional things that we want to make sure to mention for the audience that's listening. Tuesday, August the 7th, many of you have marked your calendars. If you're just now learning about it, mark your calendar - The Voice Of Healthcare Summit at Harvard Medical School at the Martin Conference Center. This is a big deal, an incredible lineup for this thing. The website is We will link to that as well and we will continue to mention that as we get closer. And the other part is that we've got a Voice Of Healthcare flash briefing. Matt is that is up and running?


Dr. Matt Cybulsky: [00:23:49] It's up and running. We just got clearance and we're going to start having daily episodes every business day starting Monday.


Bradley Metrock: [00:23:57] Awesome, awesome. So a couple of things that you want to make sure everybody knows?


Dr. Matt Cybulsky: [00:24:01] Yeah, just make sure you add it to your flash freezing and you can hear it on the way to work or while you're having your coffee.


Bradley Metrock: [00:24:06] There you go. There you go. That's what we're here for.


Bradley Metrock: [00:24:13] Tama, incredible fountain of insight. Thank you for joining us, sharing some your time with us, and your experience as well.


Tama Duffy Day: [00:24:20] You're very welcome. I encourage everyone to also go on to the Gensler Design Exchange podcast where I've interviewed other healthcare industry experts. It really aligns nicely with the podcast that you're doing, so thank you for us in connecting these two.


Dr. Matt Cybulsky: [00:24:35] Yeah, we really should to do that. Thank you so much for coming on today. It was fantastic.


Tama Duffy Day: [00:24:39] Thank you both.


Bradley Metrock: [00:24:40] For The Voice of Healthcare, Episode 10, thank you for listening and until next time.

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