Derek Parker and the author, Sara O. Marberry

Derek Parker and the author, Sara O. Marberry

Through his building designs and emergence as an international leader, Derek Parker is arguably at the top of the list of architects who have inspired the healthcare industry to innovate, elevate, and revolutionize. He has significantly impacted healthcare building design. His accomplishments include creating breakthrough innovations in healthcare facilities, cultivating a practice to grow from the local level to an international entity, and providing visionary leadership to spur healthcare designers to respond to changes in the industry.

In 1964, when Bob Anshen died unexpectedly, Parker stepped into a leadership role at Anshen+Allen, a firm he joined in 1960, expanding and elevating the size, scale, and breadth of the firm's work and placing it on the international stage. His strong conviction that health and education are the foundation of civilization led the firm to focus on healthcare and academic design.

Parker has approached his projects as an opportunity not only to further the goals of a healthcare organization, but also to advance the state of healthcare design. Known for introducing unconventional healthcare design elements, such as the world's first intensive care unit, that are now commonplace and replicated by others, he is a strong advocate of evidence-based design. One of his greatest contributions to the field has been his ability to instill a passion in his colleagues to pursue new directions in healthcare design, cultivate deeper relationships with clients and doctors, bridge the gap between healthcare providers and healthcare designers, and build organizations to elevate and transform the environment of care.

Over a career that spans 45 years, Parker has designed projects in 15 countries, given hundreds of presentations, written more than 18 transformative works, and founded, been a member of, or advised more than 25 organizations dedicated to improving healthcare such as the Robert Wood Johnson Foundation and the National Academies, and served 15 years as a founding member of The Center for Health Design's board of directors. He is Director Emeritus of the U.S. operations and is a director of the firm's U.K. practice in London. He's also involved in developing a medical waste-to-energy system that he one day hopes to market to healthcare organizations. In his spare time, he likes to sail his 35-ft. sloop on San Francisco Bay.

I visited with Parker at his home in Tiburon, California. He and I have known each other since the late 1980s when we both served on the Symposium on Healthcare Design's Advisory Board, who were the group of individuals that founded The Center for Health Design in 1993. Parker, dressed casually in khakis and a royal blue polo shirt, sipped a glass of red wine while we discussed his career, the healthcare design industry, Fable Hospital, and much more. Here's an excerpt of our conversation:

Sara O. Marberry: Let's start by talking about Anshen+Allen and how the firm got into healthcare.

Derek Parker: When I joined the firm, it was a generalist practice of approximately 30 people. Bob Anshen and Steve Allen were terrific guys in their 50s who could not have been more different from each other. After designing a laboratory project nearby, they got their first hospital project, Good Samaritan in Santa Clara, California, in 1962. Bob gave the project to me. I didn't know anything about designing hospitals-I thought pediatrics was care of the feet-but I became fascinated with the complexity. It wasn't just design for the sake of design; you had to know what you were designing for. So, for six months, I worked as an orderly at a hospital to learn how a hospital functions.

After that, I became very interested with the notion of whether design has a role in health. Then I stumbled onto John Dewey's statement, “Health is first liberty.” That resonated with me because a healthy person or child can be educated and educated healthy people are the foundation of civilization. So, my next question was, “Does architecture have a role in health?” I became convinced that the built environment made a difference in the quality of healthcare.

Marberry: What healthcare building that you have designed are you most proud of?

Parker: My personal best project is Children's Hospital at Stanford University Medical Center. Lucile Packard was a great client and Langston Trigg was a great project director. The story of how we got that project is interesting. Stanford had put together a short list of seven firms. During the interview process, I had somebody on the inside telling me how they were going. The interviews were being held in the auditorium in the old Children's Hospital. The selection committee, which was mostly wealthy, intelligent, local people, sat in the front two rows. The lectern was placed near a door where the teams would enter the auditorium. As luck would have it, I was number seven out of seven. The first six teams came in with 10 to 15 people that included electrical engineers, structural engineers, landscape architects, interior designers, and so on talking about themselves. When my turn came, I walked in alone, sat down, and told them that it wasn't about whom you had on your team and what their experience was, but it was about kids. My wife Nancy and I had lost twins so I knew what that experience was like. They told me afterwards that I was the only architect who came in and talked about children. How stupid is that? It's so obvious. So, it turned out to be a great project that I'm very proud of with many groundbreaking features, such as designing the circulation around a courtyard and creating backstage areas so that parents didn't have to be exposed to all the hustle and bustle of the hospital. There is a sense of daylight, gardens, and vegetation almost everywhere you go-that was the big idea back then.

Marberry: I've heard you say many times that architects are only as good as their clients.

Parker: That's absolutely true. We can only do good work when we have a vision-driven client. They are very rare. Jonas Salk, Lucile Packard [Stanford Children's Hospital], Blair Sadler [San Diego Children's Hospital], Ed Schroeder [St. Joseph's], Alan Yordy [Sacred Heart Medical Center], and Tom Tonkin [Community Hospital of the Monterey Peninsula] are a few that come to mind.

Marberry: Did you have a role in shaping their vision or were they absolutely driven by something?

Parker: That's a good question. They have to be somewhere along the path. So then it becomes a question of how you take those values, energy, and commitment to quality and channel it so that it's effective. Architectural skills are very good at facilitating that process. But you have to know what your skills are-what you can do that is unique. Eventually, you develop enough self-confidence. One of my colleagues once told me that healthcare architecture doesn't begin until age 60; because around 60 you begin to feel that you know what you are doing. And, he's absolutely right. It's too complicated. The reason is that the feedback loop in healthcare is so slow. If I were a doctor, I might see about 30 patients a day. As an architect, I might only design 50 buildings in my whole career. So, by the time you walk into the front door of a new hospital, you're 8 to 10 years older than when you first sat down to design the building. That in itself develops confidence. And, the more self-assured and confident you are, the more people let you do what you want to do.

Marberry: I've also heard you say numerous times that as a healthcare architect, you don't design buildings, but rather you design or
ganizations.

Parker: Well, Kirk Hamilton [Texas A&M, WHR Architects] heard me say that once and went and did something about it-he is probably the first healthcare architect to get a PhD in organizational development. I very much respect his contribution in that area. Basically, healthcare architects design systems to help organizations function and realize their values. And then we have to wrap it up in something that inspires and keeps the rain out.

Marberry: Which architects have inspired your work?

Parker: As an architect, you cannot ignore Louis Kahn. I'm also very fond of the work of I.M. Pei and Renzo Piano. And, of course, LeCorbusier, Mies van der Rohe, and Frank Lloyd Wright. But the most influential architect in my life is someone completely unknown -the person who designed the Christ Church Cathedral at Oxford University in the U.K. That was the building that inspired me to become an architect when I was 16 years old. There have been other inspirations outside of architects, in nature, for example. You can't go to Muir Woods and not feel you're experiencing architecture. Or to the desert in Arizona.

“I thought we needed some credibility and the best way to do this was to start collecting data and making the case for these evidence-based design concepts we were talking about. We also needed to get the healthcare providers involved in this work.”

-Derek Parker

Marberry: You told me once that you wanted to be remembered as a good mentor. Who have been your mentors?

Parker: Certainly Bob Anshen and Steve Allen. And many of the individuals who have been on the board of directors at The Center for Health Design; Blair Sadler, Len Berry [Texas A&M], Kirk Hamilton come to mind.

Marberry: Who have you mentored?

Parker: I've always made myself available to people at Anshen+Allen. Generally, those who come to me are people who want to go beyond their job responsibilities and learn from someone else. That's about ten percent of the people. I am also teaching the only class on design in the world to graduate nursing students at the University of California-San Francisco, which I really enjoy.

Marberry: What does it take to be a good mentor?

Parker: Being a good mentor is being available and genuinely interested in what others are doing. Nurturing, helping, and directing others is a great privilege. The mentoring process is a highly informal, highly personal process.

Marberry: Before you stepped down from The Center for Health Design's board of directors last year, you had served more than 15 years with the organization. You were actually the one who suggested that healthcare providers needed to be engaged in research and helped to create The Center's Pebble Project research initiative in 1999. Why did you think this was so important?

Parker: I had been pushing The Center for a year or two before then to adopt a research agenda. As an organization, we had spent about 10 years mostly just holding a conference talking about ways in which the built environment could affect the quality of healthcare. I thought we needed some credibility and the best way to do this was to start collecting data and making the case for these evidence-based design concepts we were talking about. We also needed to get the healthcare providers involved in this work. It just so happened that Blair Sadler at San Diego Children's Hospital had the perfect project-a convalescent care hospital in which he was taking the same patient population, same staff, and moving them from an old facility into a new one. My firm was the architects, and so the idea for the Pebble Project was born. I didn't anticipate the nerve that the Pebble Project would strike in the industry. It was an innovative idea and many people became energized by it-there are now more than 50 participants. The challenge is to continue to keep it innovative and energized because the potential is enormous. Of course, we have a tendency in America to over-hype everything, and I think to some degree we've done that with evidence-based design. I've been hyping it for a long time. The point has now been made, now how do we make it more credible? Hopefully, the data coming out of the Pebble Project will continue to do this.

Marberry: You were also the one who came up with the idea of the Fable Hospital. Tell me how that happened.

Parker: I was scheduled to give a presentation with some colleagues at a conference. The night before, I had a drink with Kirk Hamilton who told me about a physician he had heard of who used the power of stories in his presentation. I was intrigued by that idea. That night, I realized that my part of the presentation was just awful. So, I decided to create a story around an organization that had used everything that we knew about evidence-based design to build a hospital and tie those decisions to cost savings. I had some information, and what I didn't have, I made up. I designed the perfect client, perfect project, and perfect process; incorporated all the data that I knew of from the Pebble Project and came up with a savings of $12 million. The next day, I presented it as a real project and at the end I told everyone I had made it up. Len Berry happened to be in the audience and he was the one who took the idea of the Fable Hospital and led the effort afterwards to develop the business case for a better building. I don't know if I would have done anything else with it if Len hadn't been there that day. He was able to work through my hyperbole and put together something that was more credible

Marberry: Has Fable helped change the thinking of the healthcare industry, which mostly tends to just look at the short-term costs and not the long-term return on investment?

“It's too early to tell about healthcare reform in America, but if everyone does have access to healthcare, that means there will be 50 million more people in the system.”

-Derek Parker

Parker: I don't think so. The capital people still don't talk to the operational people. Getting access to that additional piece of capital required to build a better building is difficult. It is very expensive to build a poor hospital and only a little more to do it right with a one-year return on the additional investment-certainly better than my 401k. However, you just can't do it unless you have a values-driven client-one that is willing to find the right balance between capital spending and performance. When you spend time in a hospital as a patient this really hits home. Recently, I spent 14 days in the hospital recovering from a knee operation. The doctors and nurses were terrific, but the environment was appalling. The nurses were embarrassed by it. After I got home, I took one of the nurses on my unit out to lunch and asked her about it. “We're powerless; we have no control,” she told me. So I wrote the VP of Nursing, who did not respond. I then sent an e-mail to the CEO and he immediately asked me to meet with him. When we met, I told him that I wasn't there to complain, but was coming at it as an informed patient to see if I could help make it better. We have a responsibility when we've got knowledge to do something about it. Later, I received an e-mail from the VP of Nursing who said she'd just done rounds on that unit and that they were going to renovate it. What is sad, though, is that the nurses on that unit thought they couldn't make a difference.

Marberry: What are some of the things driving changes in the way healthcare buildings are built and operated?

Parker: The green building movement and environmental responsibility. Also technology is changing boundaries among specialists. In t
he future, because of technology, the only human being in the operating room will be the patient. It's too early to tell about healthcare reform in America, but if everyone does have access to healthcare, that means there will be 50 million more people in the system. How is our current infrastructure going to handle that? It may mean changes in the physical structure. But we have a moral imperitive to include all in the American healthcare dream. HD

Sara O. Marberry, is an author, blogger, tweeter, and Executive Vice-President of The Center for Health Design, which is located in Concord, California. She has worked in the healthcare building and design industry since 1988 as a marketing consultant, speaker, and nonprofit executive.
Healthcare Design 2009 November;9(11):36-44