Robert N. Mayer, PhD

President, Hulda B. and Maurice L. Rothschild Foundation

In the past few years, under Mayer's direction, the Hulda B. and Maurice L. Rothschild Foundation has funded projects for the Pioneer Network, Planetree, Society for the Advancement of Gerontological Environments, The Center for Health Design, and others. In all of his projects, Mayer is an active participant, often guiding the direction of the work and pushing the project teams to go beyond the norm. His interest in bridging the gap between acute care and residential care design with a focus on culture change, as well as improving building codes and standards, has resulted in him reaching out to many different organizations to initiate projects.

As the leader of this small foundation, Mayer has spent the past 25 years funding projects that help improve the quality of life for seniors and, in recent years, patients in hospitals. He became aware of the design of the built environment about 15 years ago, when his interest shifted to culture change. Behind the scenes, Mayer has been quietly but forcefully pushing the healthcare industry to embrace new concepts that are person-centered. The Rothschild Foundation has been actively supporting projects that focus on the built environment of healthcare; Mayer is truly a leader in this area.

Todd Hutlock: While you don’t actually design buildings, you were still voted as one of the most influential people in healthcare design. What do you see as the connections between what you do and the healthcare design industry?

Robert N. Mayer, PhD: The mission of the Rothschild Foundation is to find creative ways in which to improve the quality of life for elders in long term care communities, as well as to improve the experience of patients and families in acute care settings. Therefore, I have a great deal of respect for those in the design field who create built environments throughout the country with the goals of enhancing that quality of life and that experience.

It is an important strategy for us at the Foundation to try to eliminate barriers for those, such as healthcare design professionals, working hard to support person-centered care. When meeting with colleagues in healthcare design across the country, I was frequently told that a variety of regulations seemed to unintentionally limit designers’ freedom to create wonderful places for elders to flourish and for patients to heal. Yet, no professional or advocacy organization appeared to be addressing this particular issue. That is why I have made a major commitment to personally reach out and to build bridges to many national regulatory communities in order to craft regulations which better balance our desire for safe and secure built environments, with the equally important need to recognize person-centered care values; to bring providers, designers, and the regulatory community together to recommend changes to existing national healthcare regulations which will enhance quality of life for healthcare communities across the continuum of care. In so doing, I hope to reduce and, in some cases, eliminate some of the historical barriers to more innovative healthcare design.

Hutlock: How have you seen the healthcare design scene change and evolve over the course of your career?

Mayer: I would note two important changes, both of which continue to pose challenges for the design community. The first is the growing recognition of the importance of listening to the voice of those receiving care. Historically, healthcare design was the purview of the designer as directed by the provider, owner or developer. After all, they were the customer paying the design fee. The customer would selectively decide which members of their board and staff, including administrators, clinicians, support departments, etc. to include in the design dialogue. Over time, there has been a growing realization that a very important element was missing from that conversation; the patient or resident and family. A healthcare design which maximized efficiency, safety, sustainability, and use of technology, did not necessarily lead to a positive experience for those receiving care. In fact, while clinically excellent, healthcare built environments could be very cold, non-supportive, alienating and isolating, unpleasant places in which to receive care.

Initially, designers employed ad hoc focus groups to attempt to gain feedback from family members, patients or residents. Lacking a continuing dialogue with the design team, this approach had very limited usefulness. Those receiving care had limited knowledge and lacked the necessary context to be helpful much beyond simple questions of surface finishes. It is only as this episodic contact has slowly begun to morph into the inclusion of representatives of those receiving care as full members of design and development committees that the design dynamic has really begun to change. When integrated into the full dialogue surrounding design decisions, family members, patients and residents become highly valued sources of important insights as key decisions are made.

The second change is the growing understanding of the importance to any healthcare provider of creating a strong vision and sense of values, before engaging a designer. Historically, the practice has been to first engage the designer and then figure out what kind of healthcare built environment to create. This process was often forced by a provider waiting too long for a much needed expansion or renovation, and then not having the time to engage in a serious dialogue with their various constituencies and users about the values and vision underlying the kind of environment they should be developing. Alternatively, the careful consideration of these questions helps to dictate some of the qualifications for the kind of designer the provider or developer should engage, thus assuring a far better match between designer and the desired outcomes for the project.

Hutlock: How has your role in the industry changed over the course of your career?

Mayer: I am really on my third career at this point. In my first career, I led the management resources function of a Fortune 100 corporation. In my second career, I founded a home health corporation. I didn’t really even contemplate healthcare design until I began to work full time for the Rothschild Foundation about 1990. Then, it was a gradual evolution and recognition of the power of the built environment, which grew out of our grantmaking in eldercare. We were working very hard to bring various aspects of person-centered care to the attention of the industry and to consumers as a means of substantially improving quality of life for elders in long term care communities.

Frankly, despite employing a wide variety of strategies, we were not gaining much traction. In meetings with industry colleagues to discuss barriers to change, somehow regulations were always a part of the conversation. Unfortunately, at that time members of the regulatory community were often not welcome at industry conferences, so I had to resort to meeting with some of them privately over a dinner we organized in 2004. I explained that it was my belief that we all were working towards some common objectives to improve quality of life for our elders, and there ought to be a way to work more closely together so as to better avoid working across purposes. Because we are an unaffiliated and independent organization, I offered for the Fou
ndation to take the lead. They agreed.

Eight years later, we now have six Rothschild Regulatory Task Forces comprising some of the nation’s leading designers, regulators, providers, and consultants, working closely together to create supportive regulations ranging from the Life Safety Code, to the ADA Standards for Accessible Design, to the FGI Guidelines for Design and Construction of Health Care Facilities. I expect and hope that my role and that of the Foundation will continue to evolve as our relationships with these many regulatory bodies continues to grow and mature.

Hutlock: How do you envision the healthcare industry changing over the next decade in the wake of healthcare reform?

Mayer: I believe that passage of the Affordable Care Act will only serve to accelerate change that is already occurring in our healthcare system. While we tend to focus more on the acute care side, that change will ripple throughout the entire continuum of care.

  Some of the most visible drivers of change include:

  1. The need for more capacity. As more people are covered by health insurance, they will seek increased medical care. Constrained by current capacity, more acute healthcare will be delivered in alternatives to the large institutional medical campus. We need to think about how to design these locations, whether it is a retail-based service or a free-standing immediate care walk-in clinic.
  2. Changing demographics. More than 40 million Americans are now age 65 or older, and that number will increase as the Baby Boomers age. Already, over a third of hospital discharges are patients over age 65, so hospitals will need to be re-configured to support this aging cohort.
  3. Funding. The Affordable Care Act provides substantial funding for Home and Community Based Services to assist Medicaid beneficiaries live in the community and to avoid institutionalization. Therefore, long term care will be delivered less in traditional large scale nursing homes and more in small household units, co-housing, Naturally Occurring Retirement Communities, PACE Programs, and universally designed homes.
  4.  Boomer expectations. Boomers are already demanding that products and services reflect values of courtesy & concern, community, meaningful engagement, comfort & dignity, information, and choice. They will begin to demand this of their healthcare experience, as well. The Act’s focus on satisfaction will turn greater attention to a closer examination of how we improve the patient or resident experience.

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

Mayer: This is perhaps the hardest question of all to answer, because I find myself constantly in awe of the great many professionals from widely diverse fields who selflessly donate their time and talent to create better places for our society to live and to heal. Many serve on Rothschild Task Forces, and in that context they have all been my teachers, mentors, and role models. Further, I am reminded that although progress has been made, relatively few of our acute and long-term care communities in this country exhibit a strong commitment to person-centered design and care. So, I am motivated by the fact that we have a lot of work yet to do together.

Being a born-and-raised Chicagoan, I find it very difficult to ignore the influence and importance of the Chicago School of architecture. One architect associated with that school and the father of the skyscraper, Louis Sullivan, stated, “form ever follows function.” Based upon my experience, I have modified this a bit to suggest that in healthcare, form follows regulation. In the darkest days of World War II, Churchill told the British House of Commons, "We shape our buildings, and afterwards our buildings shape us"; a simple reminder of the significant impact on our healthcare experience and potential for improving healthcare outcomes that is possible through good design.

Click here to read the entire list of Most Influential People in Healthcare Design 2012.