Jain Malkin, CID, AAHID, EDAC

President, Jain Malkin Inc.

Jain Malkin is a leader in the field of healthcare interior design and has always been on the cutting edge of the latest design trends. Not only designed for style but always stylish, her projects display a knowledge of evidence-based design to back up every choice she makes.

Malkin is deeply passionate about healthcare design and has worked hard over the course of her career to promote best practices in the field. She has written several books, and penned dozens of articles, spoken at conferences big and small, all while leading a successful design firm that emphasizes evidence-based design and the patient experience.

Considering her stature in the field, long history of quality design work and innovation, and reputation as a thought leader, Malkin has certainly made her mark on the healthcare design industry. She continues to be a vital and active voice in the field, taking an active role in multiple design projects year after year, each one exquisitely designed and tailored to its individual space and situation.

Todd Hutlock: You've been on our list of Most Influential People in Healthcare Design every year that we’ve presented it. To what to you attribute your longevity at the top of the industry?

Jain Malkin, CID, AAHID, EDAC: I wonder about that myself! I doubt that designers and architects under the age of 40 are aware of the significance of my early books, which are now out of print. Acquisition of information used to be a very tedious endeavor prior to the Internet. When I wrote the first book on medical and dental space planning, there was one book in print on hospital design and few journal articles on any healthcare design topics. One had to use a card catalog (remember the Dewey Decimal System you learned about in grade school?) in the library to  access resources. Since so little had been written, I spent a year sitting in hospitals observing operations from the patient's point of view―always trying to look through their eyes. My degree in psychology prepared me well for this and also made me very comfortable reading research. I came away with hundreds of photos and many pages of notes and interviews by the end of that year, which eventually found their way into articles I wrote about how things could be improved. I spent another year visiting physicians' offices, observing flow, asking lots of questions, and taking many photos. This was such a laborious process that it took years to learn about the various medical and dental specialties. I felt compelled to put this knowledge into a book to help other design professionals achieve competency by a much less circuitous path. That book has been in print for about 30 years and I am starting to write the new 4th edition right now. Despite many fine books on healthcare design, this book is still the major reference on this topic.

My book, Hospital Interior Architecture, was published in 1992 and it was the first book to propose a research-based approach to design. At that time the design profession had become very good at understanding, from a general viewpoint, what constituted good healthcare design, but there was very little known about the needs of specific patient populations. This book was an attempt to fill that need by finding all the research that existed to guide design for pediatric facilities, birthing centers, critical care, rehab, and so forth, as well as research for long-term care and congregate care. A chapter on wayfinding design bundled together much of the research on that very important topic. The subtitle of my book was "Creating Healing Environments for Special Patient Populations." At the time, the term "healing environment" was unfamiliar and I wondered if anyone would understand it. Hard to imagine this now since the term has become so ubiquitous. 

So to get back to your question, I would say that architects and designers who were working in the field at the time this book was published recognized the scholarship that went into writing it and had an appreciation for what it took to discover all that research in a world without the Internet. Imagine a time when the only way one could access information was from the printed page. Books had a much longer life than they do now. I look back at my book, A Visual Reference for Evidence-Based Design, published at the end of 2008, and the information in it about infection control, for example, was new to me and new to most of us in the healthcare design arena. Because of the Internet I had access to so much information including a plethora of clinical journals and The Center for Disease Control’s guidelines, which enabled me to "package" this information in a way that is meaningful for other design professionals to save them the hundreds of hours of research to educate themselves on these topics. I guess you could say that I love to share information and try to influence people about what I think is important. I am very passionate about healthcare design.

As I look back on my career, one of the most personally satisfying endeavors was the summer course I did for 14 years at Harvard in the Graduate School of Design. Attendees were largely practicing healthcare architects and often some nurses and physicians in the mix. Although the topics varied somewhat, it was largely the design of healing environments, using research to inform design. The course always included a design charrette in which―free of the constraints of budgets and clients―architectural teams would create astonishingly imaginative projects. Harvard was highly skeptical about offering courses in healthcare design when I first approached them, but it turned out to be successful and paved the way for numerous healthcare architects to teach highly valued courses during the summer.

I think people respect that, in my books and lectures, I don't promote my own firm’s work; in fact, I rarely show it. I celebrate the work of other firms. I am always searching for excellent healthcare design and, in that regard, I would like to thank the many architects and designers who have so generously shared their projects with me for publication in my books and for keynotes and speeches. I love promoting great work; this is what advances our field.

Hutlock: One of the comments I hear about the healthcare design industry of late is that now that we have established a set of evidence-based design parameters that most designers adhere to, we see less and less innovation. Do you agree or disagree?

Malkin: I disagree with this viewpoint. It would be irresponsible as designers to not use the evidence that is available to enhance patient and staff safety and to make patients more comfortable. This should be a baseline. However, there is ample room for innovation in the area of operations
in order to eliminate waste and make better use of resources. The redundancy that exists in almost every hospital in terms of procedures that often do not add value and the lack of coordination of care among caregivers with regard to individual patients is still shocking. The number of "never events" that occur, when it is known how to avoid them, is puzzling. There is real innovation in the application of Lean principles to hospital operations, but how long will it be before these become mainstream? Not everyone thinks that the Affordable Care Act will have a positive impact on healthcare, but I look forward to the possibility that it will force hospitals to root out waste and achieve greater efficiency.

All architects and designers employ relevant building codes yet this does not stifle innovation. Each piece of research or study, by definition, looks at a narrowly defined issue to be able to reduce the possibility of confounding variables. One can gather all studies related to the design of a patient room, for example, and apply them in such a way that the end result is unique. Cannon Design is designing the Jacobs Medical Center, a new major hospital, for UC San Diego located in my hometown, La Jolla, California. UCSD is known for challenging architects to do innovative work on their campus. I recently read an article in the local newspaper on features of the patient room, and I can’t wait to see it when it opens in 2016. Based on evidence about strategies to reduce hospital-acquired infections, give patients control over the sensory aspects of the room, and to provide education and a healing environment, it appears that the room may be a creative response to application of research.

Palomar Medical Center West, a mega-sized replacement hospital designed by CO Architects, will soon be open in Escondido, San Diego County. It is a Center for Health Design Pebble and the incarnation of Fable Hospital, a hypothetical construct developed by CHD incorporating the most important evidence-based features and the associated return on investment. Derek Parker’s inspired leadership when he was with Anshen + Allen informed the direction of this project with an emphasis on sustainable design and Lean principles as well as EBD. The PPH leadership team and CEO are highly motivated to follow through with research. I expect this to be a project that will teach us much about EBD and the return on investment. 

There is another way of looking at the issue of whether EBD limits innovation. Think of this analogy: the most inventive chefs start out with a degree from a culinary institute where they learn the basics as well as food chemistry. This does not deter them from later using their imagination to innovate, but they would not be able to do it without first understanding how to cook. Popular TV shows on cooking, such as Iron Chef and Chopped, require chefs to use the same ingredients yet they each develop highly imaginative creations. In fact, Chopped is so restrictive that each contestant must use all five, often really strange ingredients supplied in a basket, in each of the dishes. Yet the creations that result could not be more different from each other. The same thing can be done using EBD as a platform for creating innovation. 

Hutlock: Your projects are always unique and individualized to the particular space and situation of the facility, yet they all have a distinctive “Jain Malkin look” that identifies them as your work. How would you describe that “Jain Malkin look” to someone unfamiliar with your work?
Malkin: Thank you, Todd, for the kind comments about my firm’s work. We do not have a “signature” style because each healthcare organization is unique and the design must be appropriate for the community served, but I agree that there is a distinctive look about our work. We pay a lot of attention to ceilings and lighting, we employ a robust use of color, and there is great attention to detail. Above all (and I could stand on a soapbox and rant about this for hours), we carry design details from the lobby into patient care areas, including procedure rooms. It is dispiriting to read that a hospital has won a design award because "it looks like an art museum"―meaning austere and minimalist, white with white accents. Too many new hospitals have great design in the lobby, but it drops off abruptly in patient care areas where one often sees no design detailing, no color, and a basic acoustic tile ceiling and lighting. That this should be happening now, so many years after we have learned from Planetree about the importance of making the environment less intimidating and institutional, is inexplicable.

Hutlock: Obviously you influence and inspire many people in the healthcare design field. Who influences and inspires you in your work?

Malkin: So many firms are doing great work today. I love the work of ZGF, Ellerbe Beckett (now AECOM), and Perkins + Will. And I am enchanted by Philippe Starck's environments. A consistently imaginative firm with a definite signature is Oklahoma’s Elliott + Associates Architects (Rand Elliott); their interior architecture always has great composition, texture, color. I am very attracted to their work. 

As for "starchitects," Zaha Hadid and Tadao Ando―certainly at different ends of the aesthetic spectrum―are among my faves. It wasn't until I spent a day at the Guggenheim exposed to the entire body of Hadid's work―much of it unbuilt at that time―that I realized what a genius she is. Although most have never been manufactured, she has designed an automobile, household utensils, and other products that have been superbly conceived and are exquisite to the eye.