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20 September 2018

Dr. Andrew Ibrahim, HOK’s Healthcare CMO, Has Big Ideas for Redesigning Healthcare Delivery

A surgeon and researcher, Ibrahim has spent the past decade studying medicine, health policy and design. Now as the first-ever chief medical officer for HOK’s Healthcare practice, he’s applying his knowledge of medicine and architecture to improve patient outcomes.  

Before he discovered the field of medicine, Dr. Andrew Ibrahim, a resident surgeon at the University of Michigan, dreamed of being a designer. As a grade school student, Ibrahim would race through his homework only to turn the paper over and plan a city.

“I’d map where everything would go: the police station here, the commercial district there, residential neighborhoods over here,” recalls Ibrahim. “I loved thinking about how to co-locate the essential elements of a city so it would function optimally.”

When he was older, a new fascination took hold. With several of his family members dealing with health issues, Ibrahim became inspired by the doctors he’d meet on visits to hospitals and clinics. As an undergraduate at Case Western Reserve University in Cleveland, Ibrahim majored in pre-med and was preparing to enter the medical school a year early when he realized he hadn’t fully explored his childhood interest in design. He deferred entry to medical school so he could complete a year of foundation coursework in architecture and planning at The Bartlett School of Architecture in London.

“I came back to med school energized,” says Ibrahim. “My first naïve question was, ‘OK, who are the architects in the medical school who plan and design healthcare systems?’ Of course, there weren’t any. But I was told that if I was interested in healthcare delivery and design for communities and regions, I should understand the policies and funding that guide those decisions.”

So that’s what he did. As a Doris Duke Fellow during medical school, Ibrahim held joint appointments at Johns Hopkins University and the Institute of Medicine, allowing him to study the impact of the Affordable Care Act on care delivery. Later, as a Robert Wood Johnson Clinical Scholar at the University of Michigan, Ibrahim built on that work and published several policy evaluations on both the benefits and unintended consequences of different care delivery models and used that information to begin redesigning alternative delivery models.

In recognition of his growing expertise at the intersection of health and architecture, the American Institute of Architects invited Ibrahim to join its Design & Health Leadership Group. In that role he met Paul Strohm, HOK’s director of healthcare. The two discovered they shared a lot of ideas about enhancing healthcare design. We’ll let Ibrahim explain a few of those concepts in his own words:

What caught my attention about HOK was this idea of designing hospitals that are more than just aesthetically beautiful. They need to function at a high level. That’s appealing to someone like me whose formal research training is in evaluating healthcare delivery and who is on the front line seeing patients. Having a chief medical officer within the firm resonated with my vision of how knowledge of health policy and firsthand clinical experience could inform better hospital design.

The value of having medical providers as part of a design team: Unfortunately, I’ve experienced the frustrations of poor healthcare design and layout: beds that don’t fit into elevators; operating rooms co-located too far from trauma bays; back stairwells that become main traffic areas because they’re the fast way for specialists to get to the emergency room. I know designers have many competing demands when laying out a hospital, but having clinicians like myself or Kathleen Schwarz, a registered nurse and senior consultant in our New York Healthcare practice, can help prevent these design shortcomings. We can offer front-line insight that addresses the needs of the client, the medical staff and the patients.

I want to bring more clinical-face validity to HOK’s designs by incorporating better end user (e.g. physicians, nurses, patients) input throughout the life of a project. It will save our clients a lot of time and energy if people on the design side of the table have a better understanding of their day-to-day priorities and constraints.

We need to take advantage of our expertise across HOK. Some of the most fascinating discussions I’ve had about redesigning healthcare delivery have been with our architects in aviation, sustainability, sports and recreation. If we want to suggest innovations to healthcare delivery and move the field forward, we need to engage new perspectives and expertise. That means seeking their input to help us design better hospitals and also have our Healthcare team guide them on designing healthier airports, workplaces, schools, stadiums and public spaces. In that way, architecture realizes its scalable potential to positively impact population health. The role I have within HOK is perfectly positioned to do that.

We also need to measure the impact of our design ideas to ensure they’re performing as we designed them and use the data we collect to inform our future design. From my work with the AIA, I’ve realized that as a profession we have a lot of opportunities to improve how we measure and research our design of healthcare systems and facilities. I’m hopeful that, armed with better evidence, architects soon will be at the forefront of policy and research summits to guide timely debates on healthcare spending.

Healthcare designers can learn a lot from turn-of-the-century surgeon Ernest CodmanAs a surgeon and member of the Harvard University faculty in the early 1900s, Codman developed the then controversial idea of tracking the health outcomes—good and bad—of patients he and his colleagues treated at Massachusetts General Hospital. When he was rebuffed for fear the results might hurt business, Codman opened his own hospital (appropriately named ‘End Result Hospital’) that documented the outcomes of his patients. Embarrassingly, it has only been within the past few decades that surgery as a profession has acknowledged that Codman was right. Of course we should track the impact of our operations and see if they help or hinder patients. We should approach hospital design the same way. We should know how it is performing and how it can be improved. We’re seeing some of that now with more post-occupancy evaluations and evidence-based healthcare design. But we can and should be doing significantly more with more rigor.

One thing that keeps hospital administrators up at night is the unprecedented rate of mergers and consolidations brought on by the Affordable Care Act and the need to manage risk. When I was a kid, nearly all the hospitals in my hometown of Cleveland were independently owned. Today all those hospitals are owned by one of two healthcare systems. It’s the same in cities across the U.S. There’s no such thing as an independent hospital. From a design aspect, the people who run these hospital systems are no longer dealing with a challenge as simple as renovating a floor in a single hospital. The issues they’re facing are much larger in scale—stretching across entire hospital networks and regions of the country—and require more sophisticated strategy and layered timelines.

Hospital administrators also worry that the big new hospital they are designing today could be outdated within five years due to the advent of a new wonder drug or procedures that can be done at outpatient treatment centers. Hospital construction is expensive. Getting it wrong can be detrimental to a community or healthcare system for decades. So there’s a real need for the medical facilities we’re designing today to be adaptable so they can be reconfigured and adapt to the changing landscape of healthcare. Beyond improving the financial bottom lines of hospitals, figuring out better ways to redesign healthcare delivery systems in the context of new healthcare technologies and policies creates an enormous opportunity to improve the health of patients on scale.

When not seeing patients or working on health policy and design, you can find me outdoors. I’m a national parks junkie. I try to hike, bike or kayak through a new national park whenever I can. My bucket list is to visit every one and so far I’m 20 deep. One of the most recent was Yosemite, which I explored after a recent trip to HOK’s San Francisco studio. When I’m traveling, I always look to see whether there’s a national park nearby. If there is, I’m extending my visit.