In October, HKS, Inc., launched its new endeavor, the nonprofit Center for Advanced Design Research & Evaluation (CADRE), which is dedicated to improving the design industry’s understanding of the built environment and exploring new ideas that inform design.

The mission of CADRE is to develop and execute relevant original research in the areas of architectural and engineering design solutions, having an impact on: end users, including occupant well-being and user effectiveness; operational performance; and sustainability of the built environment. Dissemination of this new knowledge to end users and the design community is inherent in CADRE’s organizational intent.

Tom Harvey, FAIA, MPH, FACHA, LEED AP, senior vice president of HKS, serves as president of CADRE. The executive director of the organization, and the director of research at HKS, is Debajyoti Pati, PhD, FIIA, LEED AP, vice president of HKS Inc.

Harvey and Pati spoke with HEALTHCARE DESIGN Managing Editor Jennifer Kovacs recently about the impetus behind creating CADRE, and how the group’s research is expected to impact the healthcare design community.

How and when did the idea to launch CADRE as a nonprofit begin to form?

HARVEY: For a number of years, our firm has employed healthcare clinicians—which we believe gave us an edge in designing better healthcare facilities. It also allowed us to critically evaluate the performance of our designs inside and out. This collaborative was in place before the surge of evidence-based design interest within the industry took hold. Clients then began asking for examples of projects created through evidence-based design. It was clear that we needed to conduct more rigorous research. HKS has been blessed with an extensive portfolio of projects from which we could draw conclusions about design performance. At that point, HKS brought on Dr. Debajyoti Pati, who has a doctorate in architecture—adding exceptional architectural research credentials to our team. Dr. Pati’s organizational approach to exploration and hypothesis development, along with his acumen in grant writing, has allowed us to implement research proposals enhanced by collaboration with critically valuable experts from academia and supported by external funding.

Investing in research and development has not been a typical practice for architectural firms historically. HKS has found that well-conceived research proposals will be funded by numerous interested parties. Support for research in the architectural arena—specifically in the healthcare sector where HKS began, but also in areas such as sustainability, product or design assembly development, and project delivery—is out there. Strategically, HKS leadership felt that better industry visibility, enhanced opportunity for collaboration with academia, and expanded access to research funds would result from forming the nonprofit Center for Advanced Design and Research Evaluation (CADRE).

The firm has been successful to date in acquiring seed money for research from architectural sources such as the American Institute of Architects, the Academy of Architecture for Health Foundation, the Federal Department of Health and Human Services, and a limited number of private manufacturers that support general, external research independent from their own internal R&D efforts. However, the funds to support our research, with one exception, have yet to cover the cost of the entire effort. To this end, HKS has subsidized the research in the interest of benefiting the company’s objectives and the education of our industry.

PATI: If you look at any particular research project, it progresses in phases: You do a small, pilot phase first and then you go to a larger, more detailed phase. Most research studies we have initiated so far—seven completed and another three on-going—would be considered Phase 1 of a larger research effort. In order to conduct Phase 2 of a study, you need a much larger amount of funding than what we have managed to acquire so far. That’s one of the reasons that prompted us to go nonprofit—it will enable us to create better collaborations with the academia and the industry and look for larger funding opportunities.

HARVEY: Thinking about the research versus the development role of CADRE, what we’ve been doing in the healthcare arena is traditional scientific research. It is certainly likely that similar research into performance of other building types would be valuable. Education is a purposeful byproduct of these research efforts.

On the development side of CADRE, there is fertile ground for benefitting our general architectural practice and the industry at-large, by exploring sustainability issues, new building materials and assemblies as well as technical systems, and improved project delivery methods. This opportunity for CADRE is in its infancy, but began through a green roof criteria study and collaboration with several schools for architecture to explore the application of several new products.

PATI: The other thing that CADRE has done for HKS is to cast a wider net for research opportunities within the firm. Initially, we were looking at clinic-related, healthcare research. People in other building sectors within HKS were also embarking on their own separate research projects, like our sustainability group looking at the architectural industry’s spotlight on how buildings affect resource consumption. CADRE has assimilated all of these initiatives under a common umbrella. From one nonprofit entity, we are now discussing performance issues in building types for healthcare, sports, education, hospitality, entertainment, corrections, and so forth. More importantly, we are talking about how buildings affect the people who use them, the processes they are to facilitate, the cost to deliver and operate them, and in general, how well we are doing to influence the built environment for humankind.

How will this differ from other design research efforts that exist in our industry?

PATI: It depends on how you define research. In my interaction with researchers and architects in our industry, I found that there is a wide variety of definitions. For some people, going on the Internet and Googling a concept could be considered research work. We are not talking about that here, also not the post-occupancy evaluation type of studies that people do. The research we have done would be classified as scientific research with the same rigor people apply in academia. I think the A/E industry needs to go to that level of research, which not many firms are doing. Maybe there are a couple of big firms that have done some research work, but not the industry in general.

HARVEY: Architects have been trained to observe and evaluate what has been built as a key tool in preparing to design another building. Hence, our industry is based upon learning from direct observations for the most part. We build buildings, we look at how those buildings appear to be performing from a walk-through and talk with the owners. We discuss them with our clients, and then we may re-apply or improve upon those ideas.

None of those casual observations dig very deeply or critically with sufficient discipline to really say we have evidence that this idea has performed to expectations. This led to the healthcare industry’s explosive interest in the notion of evidence-based design.

We’re beyond evidence-based design in our nomenclature now; it’s simply design that is better informed by our study of design issues in a deeper and more responsible way. All of the descriptions of how EBD is different from what architects did in the past, dealing with a more rigorous approach, is what we’ve been doing over the past several years internally. Beyond compiling current knowledge from literature searches, we have examined
our projects critically to develop hypotheses about their performance, conducted highly structured data-gathering efforts involving multiple sites and clients, applied scientific methodologies to analyzing this data, and published the results in peer-reviewed journals—the ultimate confirmation of quality, rigorous research. The commitment and investment our firm has put into this is substantially more than most of our peers can claim.

HARVEY: The healthcare industry is often whipsawn in its pursuit of the latest fad or trend relative to building design. Every time we start a new building project, the client asks what new facilities they can see that are similar. All too often, ideas seen at these sites, because they are new, are perceived to be the best approach for the future. They begin to be replicated before anybody has really studied beyond just the surface observation of how those design characteristics perform. One example of this is the universal room concept which took the industry by storm, but has not met expectations in many projects where it was applied. Another is the concept of same-handed rooms. HKS has conducted a Phase 1 study of this idea, and from our work, we are not yet convinced that it has the merits of increased safety that the industry is heavily bestowing upon it. It is an assumption at best. What we’ve learned from our first study of this concept in concert with a major university school of nursing suggests that it may, in fact, even have characteristics that are detrimental to safety due to inconsistent human behavior in how nurses work with patients.

We’re not so convinced of that finding that we are preaching it per se, but what the research tells us is that the concept, while it looks good on the surface, is not necessarily better and that we should not necessarily be promulgating it on every project that we design. Having said that, we still design around this concept when a client prefers it. But initial research has informed us that it’s not the panacea for patient safety at the bedside that many think.

PATI: Tom brings up a key issue here in relation to our discussion on design research, because if you look at the industry and the research activity in the industry over the past 40 years or so, most of the research has targeted creating comfortable environments in buildings. The study of factors to comfort through building materials, structure, wall systems, window systems, roof systems, and the like is fundamentally important to architects. What is happening now is we are going a step further and asking: Can we create a physical environment that partners with the client organization and targets some of their operational goals, such as changing organizational culture, improving safety, reducing infections, or retaining staff? Those kinds of issues weren’t design research topics in the past. That is the main difference in the kind of research we are doing at CADRE. CADRE is not the only organization doing this kind of research, but most of the people who are doing similar research are in academia. As it relates to translational research in healthcare, a gap exists between the bench (design) and the bedside (operational performance).

What are your expectations for the turnaround of results? Are these long-term research projects?

PATI: These Phase 1 studies are not. Most of our research projects get completed in an 18-month cycle. We are not talking about four- to five-year research projects. However, when we go to Phase 2 studies, those would be much longer. My estimate would be it will take at least two or three years to complete many of them.

HARVEY: I would say, though, in architectural practice, they are long studies from the standpoint of how long we have to design a specific project. What we are doing today in these 12- to 18-month studies is often too long to be a part of a specific design project for which we’ve been engaged. We acknowledge that we can’t study something new quickly enough for a project that just came in the door.

The work CADRE does is not going to displace the need for short-term, immediate investigations that our project teams conduct in the context of their project. Classically, good research simply takes longer than that. However, as CADRE builds up a catalog of research findings, we hope to extrapolate ideas from that work to apply to future projects. We feel all of our projects will benefit from this effort.

When you begin arriving at results, what are your hopes and expectations for how that information will be used?

HARVEY: Dissemination of knowledge is a fundamental tenet of CADRE. Education of our industry is a part of our mission statement. Clearly our firm will benefit from this research effort, but business development is not the principal goal. We have multiple mechanisms by which we share this knowledge as soon as it is available. You can look back over the last five years and find that we have reported our findings at every one of the major national healthcare conferences in presentations, engaged in roundtable discussions, made research papers available on our Web site, and published articles in trade publications.

Most importantly, we have generated several peer-reviewed articles published in such referred journals and books as Health Environments Research & Design Journal, the Journal of Healthcare Engineering, Environmental Psychology: New Developments, and Environment & Behavior. I would say proudly that as a firm, prior to the creation of CADRE, HKS has had more articles in these journals than any other design firm because of the level of rigor that we bring to the effort. Internationally, we have been recognized two years in a row for the Best International Research Project by the International Academy for Design and Health. So everywhere we can find to communicate our message, we try to put it out there.

It’s rather interesting in our industry that the majority of articles in which architects have historically been published, including healthcare publications, have featured the design characteristics of a new or renovated building project. It’s quite a shift for us to move into the realm of talking about design as it relates to building operational performance through research discoveries. Such intellectual discussions about how a building impacts a client’s operational performance is frankly more important than the heady discussions that can be found in most of the high design journals of the architectural industry at-large.

So what is next for CADRE?

PATI: We are discussing potential topics that we might now write for grants with people we know in academia. As I mentioned, we continue to believe that a collaborative approach is best in terms of being interdisciplinary and having people from multiple organizations. The reason we intentionally do that is we believe strongly that a collaborative model gives the best product in terms of research.

HARVEY: CADRE is an exciting new entity for HKS and the architectural industry. We look forward to rapid growth into multiple endeavors of research and development as the economy rebound permits. We intend to broaden its sphere of influence into general architectural topics, but healthcare issues will continue to comprise a major portion of our portfolio of study.

CADRE is already a strong resource to the healthcare design community and to our clients. We look forward to its continued growth by exploring new topics, and pushing deeper into subjects we have already studied by funding Phase 2 studies that we have initiated over the last four years. In short, we seek to build foundations for the future—today.

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