We couldn't bring you the Architectural Showcase issue every year without the help of our jury. Our heartfelt thanks go to each and every one of them for their outstanding service. On the following pages, the 2010 jurors reflect on their judging experiences and general thoughts on this year's projects.

Arthur Brito, LEED AP BD+C, EDAC, Director of Design, Albert Kahn Family of Companies, Kahn São Paulo

My experience as a HEALTHCARE DESIGN Architectural Showcase juror can be described by the two important activities the task is comprised of. First is the personal analytical methodology that I have developed through those years of Jury, which helped me to further evaluate my own work. That means, as a juror I had to develop a method to isolate any bias-motivated by project type, profile, or even my own mood -when I evaluate a project. In a jury, as in our daily work as designers and planners, we must learn to cut through the marketing features. Second and most important, it's a unique opportunity to learn from the in-depth discussions of healthcare projects with some of the industry leaders and, eventually, feel yourself as one! Inconsistent evaluations from juror to juror are often more educational than the consistent ones.

The one thing that caught my eyes this year was the increase on quality of the International projects. Some of this year's and past year's projects-from Mexico, Brazil, Canada, etc.-can be considered important paradigms of good healthcare design and planning with limited resources, which may be an important lesson as the Healthcare Reform evolves. Furthermore I was impressed by how the sustainable agenda is influencing most healthcare projects this year.

Joyce Durham, RN, AIA, Principal, Health Strategies & Solutions, Inc.

I have enjoyed participating the

HCD Architectural Showcase jury for two reasons. First, the submission are typically outstanding, and it is interesting to understand the thought and challenges that led to the design solutions. Second, I find the interaction with other jurors to be stimulating and thought provoking. The jurors tend to be from many different sectors of the profession and have different perspectives on what constitutes a successful design.

I found the submissions this year probably reflected the economy; the projects were smaller and less dramatic or risky. However, although the projects tended to be smaller and involve more renovations as opposed to new construction, I found the projects placed much more emphasis on the core values that drive health care design: optimizing existing facilities, patient safety, efficient operations, and the staff/patient experience.

Rick Hintz, LEED AP, AIA, ACHA, Principal, Healthcare Market Sector Leader, Perkins+Will

Being a juror is both a learning and inspiring experience. I am reminded that our profession is unique in that for any given set of problems, there are many “right” answers; it's just that some solutions are more “right” than others. The common denominator in the projects that rise to a higher level of recognition is a mastery of the rules that shouldn't be broken and a manipulation of the rules that can bend or break. The very best solutions have somehow been designed simultaneously from the “outside in” and “inside out”. My favorite ones are the rare projects that just jump out of mainstream planning and make a leap in innovation-where rational, linear, deductive, logical thought process would have never lead to that solution. Someone just had an idea pop, an “aha-like” experience. I saw a couple of those this year so it was fun to see.

The reality is that by the time a project is submitted, it has probably been several years since the design team first interviewed, programmed, and fundamentally shaped the project. And with today's incredible pace of change and the rapid exchange of ideas, the projects tend to embody-by default-dated thinking. I can't help but wonder how the soaring spaces, richly appointed interiors, elaborate water features, and extraordinarily ambitious design statements will be viewed by our healthcare clients going forward, recognizing they face very compelling capacity, reimbursement, and capital imperatives. The architect in me marvels at the artistry of many of the projects submitted but unfortunately the world is a different place these days. The challenge to all of us should be to resist the market pressures to “dumb it down,” instead calling upon our cleverness to find elegant solutions in their simplicity, those solutions that are beautiful because they work so well, that are so cleverly conceived.

Fran Hoerrmann, EDAC, AIA Associate, Community Health Design Consultant

The experience as a juror enabled me to review a wide range of projects both in scope and geography. Evaluating someone's design, intent, and result causes you to re-evaluate your own approach to design and problem solving. It was also helpful to review these entries as a group. The interchange of project strengths and weaknesses resulted in a more objective rating.

John E. Kemper, Chairman & CEO, KLMK Group, LLC

This is my second year as a Juror and I find it very interesting and professionally rewarding to review different types of projects from all over the country. It gives you a very good perspective on how the design teams approach different types of projects and how innovative the designs might or might not be. The different ratings from the jurors also allows you to see how jurors with different backgrounds might view a project very differently than you view it. In addition participating in this process is educational.

I found the projects viewed this year not as good as the ones reviewed in the previous year. I thought there were more what I would classify as “average” projects this year. The projects did not in my opinion demonstrate any new trends but did confirm the trends toward evidence-based and green design.

Bruce K. Komiske, MHA, FACHE, Chief, New Hospital Design and Construction, Childrens Memorial Hospital

It is a privilege to have an opportunity to spend a day with other like-minded professionals devoted to healthcare design and construction and preview the most current facilities that will help shape the future of healing environments for decades to come.

“It did appear that projects submitted were generally larger in scale and many had intriguing designs that made differentiating the best of the best a challenge.”

- Andrew Lane, AIA, LEED, AP

We continue to see an emphasis on public spaces and the importance they have in setting the expectations for the entire healthcare experience. More emphasis on sustainable landscaping and internal gardens and art. Don't under estimate the importance of the photographer when submitting photos for the magazine. Still need more creativity in the external design of the hospital. Many new facilities look fairly similar to those that have been designed for the last 10 - 20 years.

Andrew Lane, AIA, LEED AP, Senior Project Architect, Associate Director of Design, BSA LifeStructures-Chicago

This was my second year participating as a juror for the Healthcare Design showcase. It has been a gratifying experience to be able to see the work of so many talented people as well as participate in some very engaging discussions regarding submitted projects. The varied backgrounds of the jurors has made the project conversations diverse while ensuring Citation-winning projects are well conceived in many aspects of design.

The projects I reviewed this year were on a whole much better projects than the ones from the previous year. It did appear that projects submitted were generally larger in scale and many had intriguing designs that made differentiating the best of the best a challenge. It certainly appeared as though many of the projects had generous budgets, with extravagant public spaces. The roaring economy during these projects’ design conception probably had something to do with the lavishness. It will be interesting to compare the projects in the next few years to see if more nuanced designs are submitted, since the funding may not be available for the big “Wow” spaces.

Robert N. Mayer, PhD, President, Hulda B. & Maurice L. Rothschild Foundation

This year, the judging was significantly streamlined through the use of the Internet to transmit all of the entries in advance to the jury, and by having the jurors initially rank the submissions prior to the actual meeting together. This allowed the jurors to really focus time and attention on the most significant entries, and to use more of their time together to debate the merits of the very best submissions. I believe that the result was a far more thoughtful and careful process, that gave well-executed and presented submissions the time that they deserved in front of the panel for recognition.

By carefully selecting a wide cross-section of experiences and expertise to serve on the jury, it makes for a very rich diversity of lenses through which each submission is viewed, whether from the perspective of technology, materials, site, sustainability, space, energy use, or the patient/elder experience.

Michael A. McKay, AIA, LEED AP, Partner with Morrison Kattman Menze, Inc. Architecture-Planning-Interiors

Serving on this jury has provided a wonderful opportunity to collaborate with colleagues from all facets of the healthcare profession, from all around the world. Over my three-year tenure on the jury, we have also made the transition from paper to electronic submittals of the projects to be considered. This experience has provided an opportunity to review healthcare work from across the nation and around the world, in a setting where the concept, planning, design, and construction was discussed and debated from several points of view ranging from the user, to staff and facilities, to the planner and designer, and the public. In this context and with the ability to look back over the last several years of juried submissions, one can see the depth and breadth of challenges, trends, and convictions facing healthcare in this modern world.

Overall, the work we juried was professional and competent, with many projects of exceptional design and presence. Some were simply excellent and quite powerful. One concern I see is we need to make a better effort to connect the end result with the initial concept, mission, and values of the project in terms of serving the needs and people who will find themselves in this place. The trend is to seek larger and more complex solutions, and far too often we talk about these projects in terms of quantity over quality and aesthetic of space and place. Patients and families get lost, staff and physicians find it more difficult to deliver care in these ever-increasing healthcare structures. It was refreshing to see submissions that spoke more to a human scale, often using less architecture to address the solution. To use some words of the past, sometimes less is more.

Daniel J. Miesle, MHA, CHE, Director of UK HealthCare Facility Planning & Development, Hospital Administration

Being a juror is a challenging yet rewarding experience. The challenge is to look beyond the images portrayed in great photography so seek the answers to the core questions: (1) does the project embraced EBD elements; (2) did the project realize the desired outcomes by effectively addressing the challenges (financial, facility, or institutional); and (3) was it obvious from the submittal that the project will make a difference in the patients served and staff it supports?

The rewarding part comes in several forms. First it provides many insights into what leading-edge projects are being executed or planned, which allows me to examine what my organization can apply to projects are in planning or design. Second, by spending a day with professional colleagues, it affords an opportunity to look at projects through the eyes of others-to see things that I didn't see in independently reviewing projects.

“More projects are embracing the natural elements of light and healing elements even when on constrained sites establishing the concept that truly ‘no site has limits’ in the eye of a great designer.”

- Daniel J. Miesle, MHA, CHE

Projects submitted are improving with much more depth presented than last year. Few “wow” projects that take design to the next new level were submitted. One reason may be that few client organizations have the resources to go much beyond the basics. More projects are embracing the natural elements of light and healing elements even when on constrained sites establishing the concept that truly “no site has limits” in the eye of a great designer. Too many projects are caught in past trends without solid documentation of evidence-based research An area that is not reflected in many submittals is the impact of technology on design and in some cases are in conflict: beautiful rooms that show no evidence that technology exists. What I am hoping to see at the next level is when the “golden triangle” of EBD, healing environments, and technology are harmonized in one building.

Frank D. Nemeth, AIA, Vice President, Design Principal, HGA Inc. Architects and Engineers

My experience as a HEALTHCARE DESIGN Architectural Showcase Juror was rewarding for the following reasons: There was first of all, the exposure to new and frequently innovative work constituting a broadening experience in design trends and planning; It was a great opportunity for developing new acquaintances with diverse and prominent design professionals and collaborating in the jurying process where all of us, in any particular group, did not necessarily think alike. When it came to the final review for Citations of Merit, the differences were even more pronounced; The interaction between jurors was quite beneficial when it served to help adjust or expand an obvious set of preferences or prejudices re: form, style, planning paradigms, or regional character.

There were an adequate number of outstanding projects, but I lament the fact that some of them did not get recommended for Citation, while quite a few others were treated with higher regard than was perhaps deserving. The jury had widely divergent opinions on design quality and design substance; There was much variety and equally much repetition in areas of design character and/or style. Much depends on the quality of photography in generating a strong sense of support from the jurors. I didn't see much that could be said to represent new trends. There was stimulating work, enough to justify a showcase of HEALTHCARE DESIGN, but, overall, the design content might have been less scintillating than in previous years.

Michael Roughan, AIA, LEED AP, Vice President/Healthcare Principal, HDR

The opportunity to be a juror is an honor and privilege. HEALTHCARE DESIGN continues to receive high-quality submissions that represent the best work both in the U.S. and internationally. To be among colleagues debating the merits of the various proposals helps me validate the important trends in current practice and the vision many architects portray for the future of healthcare. I will continue to participate as long as I am invited, as the Showcase is an efficient and effective use of my time as a healthcare professional.

I believe that this year's submissions emulate the general condition of the economy and the transition from ambitious showcase projects that focused on public spaces and general patient/visitor hospitality to a more pragmatic evidence-based approach that prioritizes efficient medical practice in a time of diminished reimbursement. The more successful projects balance a retention of patient focused amenities with good medical planning. Another trend obvious with the submissions is a more focused typology that ranges from tertiary translational centers to specialty centers (i.e., cancer) and the evolution of community-based facilities that brings care to the patient rather than the reverse.

Jerry Smith, FASLA, Smith\GreenHealth Consulting, LLC, 2010-2011 Faculty Fellow in Landscape Architecture, College of Architecture and Planning, Ball State University

There was a good vibe on the jury this year. Everyone had previewed the projects and submitted their comments prior to arriving, so the discussions centered around known facts, entities, observations, and did we agree or learn from others’ input and experiences. So I felt it was a very collaborative jury this year, and the time flowed more smoothly, and the discussions more focused on specific issues of design. The outcome was a fairly unanimous agreement on Citation selection, which was our task and our goal. For me, it was a rewarding experience and I'm proud to have been a small part of it.

“Just look at the Citation winners over the past few years and you'll see that integrating and accessing nature is creating better design solutions that are patient-centric and based on research.”

- Jerry Smith, FASLA

The projects this year were generally very good, and, of course, some were exceptional. The trends I've been noticing over recent years has been toward the influence of nature in overarching design concepts and guiding principles. I've also noticed the increased attention to landscape design, from places of respite for patients and staff to a focus on views of nature from patient rooms and public gathering spaces. And with sustainable best practices leading the integration of these indoor/outdoor spaces, we're seeing more attention to roofscapes and even green roof technology incorporated into these projects. This is the second year I've been on this jury and this trend is not going away. Just look at the Citation winners over the past few years and you'll see that integrating and accessing nature is creating better design solutions that are patient-centric and based on research. It's a good thing, Martha!

Jessica Steeber, ASID, EDAC, Interior Designer/Associate Principal, Kahler Slater

It has been such an honor to be a HEALTHCARE DESIGN juror for the second year in a row. The format this year was fantastic. Being able to electronically review all the projects in my review category was so wonderful because I could take as much time as I needed to really review each entry. This allowed me to be flexible with my work schedule and see some great projects. I also appreciate the opportunity to collaborate with my peers, to discuss in more depth the projects being considered for Citations.

The projects this year were interesting. There were some really fantastic solutions based on evidence-based design and approaches to sustainability. Research and sustainable design have been very positive trends for our industry over the last five years or so. There was quite a distinction between those firms/projects who are forward thinking with their approach to planning and integrating new concepts into their design solutions! It is amazing to see the creative talent that is pushing healthcare design where it's never been before.

Jocelyn M. Stroupe, AAHID, IIDA, ASID, EDAC, Principal, Cannon Design

This was a very positive experience. This years’ electronic format worked very well. It allowed for me to spend more time with each entry in advance of our meeting and to gain a better understanding of the project's challenges and the solution that was developed. When we met face to face, we were able to discuss each project more thoroughly and to debate its merit. This led to some very interesting interactions with my fellow jurors-the ensuing debate about the work was healthy! The perspective we each brought to the table was unique since we represented good cross section of the healthcare industry and were a geographically diverse jury.

Generally, I thought this year's projects were good. There was a greater emphasis on the use of research to inform decisions, and many projects indicated that they intended to pursue studies related to their outcomes. I think this bodes well for the future of healthcare design. The best work represented planning, operations, and design equally-these were the projects that were awarded Citations.

Simon Thomas, Director of Medical Planning, Ellerbe Becket, an AECOM Company

As a HEALTHCARE DESIGN juror for the past two years, I have had the opportunity to meet colleagues from across the country in a variety of positions within our industry. Over the course of a long but extremely interesting day, we have dissected the best projects available for review each year. This has been a very rewarding experience. It has allowed me to gain an oversight of the industry for each year and to engage in some stimulating conversations about the planning and design of projects and industry trends. Seeing, reading, and discussing the range of projects submitted also gives a great insight into the marketing that appears most successful: great photography, clearly understood narrative with supporting images.

I think the quality of projects was typically very high. I suspect that this reflects not only the ability of firms to produce a nice package of information but that many firms now have “healthcare” experience and are implementing good, solid planning and design. What I find more troubling is that there seems to be no real innovation despite many project descriptions' written claims to the contrary. Sustainability is everywhere and again is written profusely in the narratives for each project. However, perhaps by the nature of the relative newness of the field, the text seems more marketing-driven than by demonstrated understanding and application.

Healthcare Design 2010 September;10(9):56-63