A. Ray Pentecost III, DrPH, FAIA, FACHA, LEED AP

Vice President, Director of Healthcare Architecture, and Design Principal, Clark Nexsen Architecture and Engineering

A. Ray Pentecost has demonstrated throughout his career that when given the opportunity to lead and influence healthcare design, he will. He has done so and continues to do so with great passion from leadership positions that have national and international influence. His national leadership roles on the Board of Directors (and as president from 2009 to 2010) of the American Institute of Architects Academy of Architecture for Health (AIA AAH) and the Board of Regents of the American College of Healthcare Architects, his international leadership as president of the International Academy for Design and Health, and his role as co-chairman of the AIA’s America’s Design and Health Initiative demonstrate that Pentecost’s peers are inviting him to take positions of tremendous influence in the healthcare design industry.

Combining his training in the field of public health and research with his passion for architecture, Pentecost has been heavily focused on identifying linkages between design and health. Presentations made in the United States and internationally, as well as articles written on the subject, have served to help elevate this issue to prominence.

Pentecost has also been an outspoken advocate for the use of research in design, a practice that is changing the way healthcare facilities, and indeed other building types, are designed. His leadership and advocacy of healthy design as a national priority while serving as president of the AIA AAH was codified when the AIA AAH board approved revised bylaws including a mission statement that embraced not only healthcare design but the design of healthy communities. The result has been a broader perspective and scope of service for the leadership of the nation’s premier membership organization for healthcare architects.

Todd Hutlock: You have held many positions on many different committees and councils and boards over the years, including a stint as the President of the AIA AAH. How does your work with these groups influence your work at the “day job” so to speak?

A Ray. Pentecost III, DrPH, FAIA, FACHA, LEED AP: Perhaps the most striking impact is being seriously humbled by those with whom I am serving. This industry has become so multifaceted, so populated by areas of specialization, that it is no longer possible to find adequacy in any single vision, voice, or passion, including one’s own. My work on committees, councils, and boards routinely juxtaposes my interests and backgrounds with the expertise and passions of some extraordinarily capable individuals, and I am regularly confronted therein with how much there is that I can respect and value in others.

Both my personal and professional networks are enriched by these terms of service. I meet people with whom I find shared interests and compatible skills, and that palette of professional competencies can be of great value when it is time to assemble a team to pursue or deliver a project. My office benefits from my ability to “connect” a team or an individual in the office to the right industry voice when a question or opportunity arises.

As my career has progressed, those things about which I care most deeply have become clearer and easier for me to articulate. With that passion comes a strong desire to pass that perspective along, to make a contribution, and to offer what I believe has the potential to be transformative, or at least useful, to my colleagues, to the profession I deeply enjoy, and to those who are touched by what we do as design and health professionals. Council, committee, and board service offers a very special kind of pulpit for the expression of those passions, and I have found that my day job benefits from the interaction and professional exchanges that accrue from exercising that voice.

One of the things about which I am particularly aware, and for which I am most grateful, is that not every company supports such service. It takes special leadership in one’s own company to see not only the value of service to the profession, but also the value of the personal and professional development that accrues to individuals engaged in such service activities. Clark Nexsen has always been very supportive of my service activity, and my deep appreciation for our Board of Directors’ continuing support strongly influences my attitude and work ethic.

Hutlock: Where do you see the healthcare industry moving in the next decade, both in the United States and abroad?

Pentecost: The next decade will be critically important for the U.S. healthcare system, and I don’t believe the answer is singular. In my experience with healthcare systems around the world, and to a growing extent in the United States, I find the emphasis is on health, not medicine. As simple as that distinction is, the implications are nothing short of profound. An emphasis on health drives a different national conversation.

The place of technology, health systems and facilities, pharma, and medicine in the economy and in daily living is different when the national focus is on exercise, nutrition, prevention, and wellness. The measures of success are different when one considers the health of the individuals in a nation. The budget priorities change. The performance incentives envision different milestones. The magnitude and extent of changes to come are so significant that they are, frankly, difficult to comprehend, but we must transition to shooting at the correct target. It won’t help the health of the United States population if we successfully continue to hit the wrong target. A great medical system alone will never guarantee individuals great health.

I understand from the health economics community that there is another dimension of this conversation that cannot be ignored. In every national economy there is a “tipping point” when one sector of the economy becomes so much bigger than the other market sectors that it throws the rest of the economy out of balance, much like a wheel that is out of balance on a car. In the United States, I am told that the window for tipping is when one sector of the economy reaches a point somewhere between 20 – 25% of the gross domestic product (GDP). Consider that healthcare is past 18% on its way to 20% of GDP, potentially before the end of this decade. That reality should shift the national conversation from one just dealing with the cost of “healthcare” to one of national security; my sense is that the urgency and priority of that truth should dramatically transform our national focus. The upward spiral of costs must be interrupted.

For design practitioners, the emphasis in the next decade is probably largely centered on the “new model” that everyone seems eager to discuss but which nobody seems ready to reveal, not so much because people are unwilling to discuss it, but because its definition has largely eluded health planners and systems analysts. Falling reimbursements for care, significant demographic shifts, and a growing emphasis on the quality of care with successful outcomes is causing most organizations to rethink how they do what they do.

No doubt there will continue to be the occasional “large” hospital project, but the unmistakable momentum of the healthcare system is away from the current delivery
model to a newer, differently structured, highly efficient, and more cost effective system. Increasingly, however, the health economist community is pointing out that efficiency is no longer the design goal that restores financial viability to our health systems. The new model, it seems, must have a fundamentally different cost structure than the one with which we are familiar and around which most of our medical care system is built.

Hutlock: You’ve always advocated the use of research in healthcare design. 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?

Pentecost: I agree with you that it is the perception for some, and perhaps not surprisingly I disagree with that view. The thought process behind the comment reflects confusion. First, I am not clear who the “we” is that established the set of evidence-based design parameters. Second, I am unaware of the “list.” And third, even if the list of design parameters existed, it would be no more valid to suggest that those parameters constrict creativity than it would be to say that the assortment of colors in a rainbow limits the artistry of a painter, or the variety of foods in a grocery store restricts the creativity of a chef. That logic seems to me to be a non sequitur.

One of the highest marks that a research finding can achieve is to be so widely accepted and highly credible that it becomes a matter of a design code or a recommended design guideline. But in the universe of meaningful and significant research frontiers, these definitive findings, as wonderful and profound as they can be, are relatively few. Evidence-based design is not a mature field with nothing more to be learned. There is still a tremendous opportunity for the discovery of new truths about design. Beyond the initial discovery, research opportunities abound to test both the various measures of the reliability of many of the findings and the host of validity issues associated with those results.

Research findings in design empower creativity because they lift the design experience beyond the insecurities of “we’ve always done it that way” to a world of confidence in which a design team can say with boldness that the research suggests clearly that this approach is more effective. Anyone who has traveled the road of creativity knows that innovation and unconstrained thought flourish to a far greater degree with a team empowered by boldness and confidence relative to one hobbled by insecurity and ignorance.

I will add, though, that the greatest potential to advance the field of evidence-based design lies in the mobilization of design and construction professions to engage in the research initiative. The academic community simply is not equipped to assume full responsibility for making forward progress in this domain. There are not enough academic researchers, nor are there enough academic resources, to move research agendas forward at more than a snail’s pace. Practitioners must be motivated and empowered to get involved, not just in using research, but in being active in conducting research. Failure to do so risks, in my opinion, condemning evidence-based design to making little more than a fraction of the impact of which it is capable.


Click here to read Part 2 of this interview.