October 1, 2013
What’s the Dean of Healthcare Design Doing in Silicon Valley?
What’s the dean of health-care design doing in Silicon Valley? Attempting to revolutionize the way hospitals are designed and built.
In 2011 Kaiser Permanente sponsored the Small Hospital, Big Idea competition. The company received more than 400 entries. One of the winning teams was Aditazz, a Silicon Valley-based tech start-up that used a computer algorithm to help create its design. The scheme features multiple spaces that encourage human contact; its common areas blur the boundaries between the hospital and the surrounding community.
In June 2011, Derek Parker boarded a plane at San Francisco International Airport. The veteran health-care architect was headed to San Diego to deliver the most improbable presentation of his illustrious, six-decade-long career. For six months, he had worked as a consultant with a Silicon Valley design start-up called Aditazz. Shortly after Parker signed on, the new company had entered Small Hospital, Big Idea—a design competition launched by Kaiser Permanente. The first round, in which the firms remained anonymous, drew more than 400 entries. Eight of the nine shortlisted firms invited to San Diego were industry heavyweights. The ninth, to everyone’s surprise, was the unknown Aditazz.
But that wasn’t the only surprise. During his presentation the following day, Parker dropped the real bomb: the hospital design that vaulted his unknown company into the round of nine had been created largely by an algorithm. Parker reached into his leather briefcase and placed a brick and a silicon chip on the table before the Kaiser Permanente jury. “I told them that these were two objects that were made of sand and baked in the oven,” Parker recalls. “Then I said that one of them is dumb, and one of them is smart. And that the smart one is the one we’re using to build hospitals at Aditazz.”
A standard computer chip is composed of hyper-pure silicon wafers that are chemically treated, etched with light, and layered atop each other to create an almost infinite network of potential electrical connections. The chip is assembled by robots in an environment whose air is 10,000 times cleaner than that found in a typical hospital operating room. It can contain one to three billion transistors—so small that 30 million of them can fit on the head of a pin. At approximately one-quarter of one square inch in area, it is probably the most complex structure humans have ever produced.
Deepak Aatresh knew a lot about designing and manufacturing computer chips. Born in Bangalore, he spent seven years at Intel, watching the industry automate as the speed and capacity of the chips he helped create increased geometrically. In 1997 he left the semi-conductor giant to found (and sell) two tech start-ups. Ten years later—now a serial entrepreneur growing bored while renovating the basement of his Saratoga, California home—he happened to view a time-lapse video of a construction site. “It was fascinating,” Aatresh says. “First the earth-moving equipment arrived to remove the earth. Then the concrete was poured where the earth had been. Then other materials were added to make a complex three-dimensional structure. I realized that this was exactly how we build chips.”
Struck as he was by the similarities, Aatresh was even more struck by the differences between chip manufacturing and building construction. In his world, the built object was conceived by computer, then baptized in a wash of complex virtual simulations that subject the still-bodiless processor to almost every possible circumstance it might experience in its working life. Flaws and short-circuits were flushed out in a digital universe, where they were easier—and far cheaper—to correct. In contrast, Aatresh found building design largely unchanged from the time of the pyramids. Ideas were sketched into drawings. The drawings were then realized by laying brick upon brick, with a layer of mortar spread between them. Yes, the industry had adopted computer design and building-information modeling software. But these were incremental changes. Aatresh believed the industry needed something exponentially different. In early 2008, on the invitation of a friend, Aatresh accepted a position as entrepreneur-in-residence at Artiman Ventures, a Silicon Valley venture-capital firm.
His big idea was still an idea. But it was compelling. “Think of human beings,” he told a colleague at Artiman. “Our forms begin with a formula synthesized in our DNA. Now imagine if we could capture all the functionality of a building in a language like DNA. We’ve already done that in the chip-design world. Why is it that in the building world we’re still drawing polygons in the sand?”
Aatresh’s proposal was anything but modest: Why not design and construct buildings the way that he and his colleagues had manufactured computer chips? Instead of multiple drafts and revisions, buildings would be designed using a computer algorithm that could ingest multiple parameters and spit out hundreds of viable options. Instead of learning painful—and costly—lessons on the construction site, why not work out all the kinks in a computer simulation? And instead of plans being relayed from designer to engineer to builder—with the accompanying risk of distortion at each step—why not coin an integrated design language that could translate smoothly into instructions for a robotic system that would cast a precise set of construction components the same way an automobile factory spits out parts?
A rendering from the winning entry for the Kaiser Permanente competition, showing the outdoor common areas.
The former chip designer knew he was dreaming big, and that his proposal needed trimming. The construction industry was simply too large a target—an estimated $1 trillion in the U.S. and $7 trillion worldwide. Aatresh knew he needed to select a specific sector. He chose health care. The life cycle of a hospital, in which various machines and departments grow obsolete at different rates, reminded him of swapping out components on a computer motherboard. And while health-care design had been chronically resistant to real change, Aatresh believed an industry strangled by soaring costs and fitful revenues might just be receptive to a paradigm shift that he believed could shorten design and construction times by at least 30 percent, cut up-front costs by at least 10 percent, and save another 10 percent on the cost of ownership. And, of course, that would provide better care.
Still, as a businessman, the idea of founding yet another software company troubled him. This wasn’t CAD or BIM, drafting tools sold on license, which, while widely adopted, had merely souped up an existing design and construction engine. The software Aatresh envisioned writing proposed to revolutionize not just the drawing room, but an entire industry, from the first client meeting to the handing over of the keys. The new product wouldn’t just help the designer represent a product in three dimensions. It would digest a complex series of parameters, and then issue hundreds—even thousands—of alternatives for the designer to weigh.
“I saw that if we tried to sell our disruptive technology to this industry, it would just reject it,” Aatresh says. “Our real value proposition wasn’t in the tool we would invent. The value would be in what the tool could produce. So I decided to tie the whole thing together. That we would become a vertically integrated architecture, design, and construction company.”
Derek Parker was born near Birmingham, England, in 1934. During World War II he and his mother lived about 30 miles outside Coventry (his father was a spitfire pilot in the RAF). He remembers being able to read by the light streaming from the burning city of Coventry, aflame after German air raids. After the war, as a young architect, Parker worked at rebuilding the city and its fire-bombed cathedral. “I learned early on that architecture is an intensely emotional experience,” Parker says. “I also saw it could be a very healing experience. The war was over. A new city was being born out of the ruins.”
Over the next 50 years, most of them at the helm of Anshen + Allen in San Francisco, Parker designed and planned more than 50 hospitals in 15 countries. “You’re not in the business of health-care design without knowing Derek Parker’s work,” says Robin Guenther, a veteran of 30 years in the field, and now a principal at Perkins+Will in New York City. “He schooled an entire generation of health-care designers.”
Parker’s hospitals evince a fervent commitment to patient care—and unfailingly establish a strong connection to nature. The Lucile Packard Children’s Hospital at Stanford University is ringed around a garden, with 26 outdoor terraces; nearly every corner of the building is linked with the outdoors. But Parker’s research has been as valuable to the profession as his designs. In 1993 he cofounded the Center for Health Design to help bring evidence-based design to health care. In 2000 he created the Pebble Project—a research project that pooled information on how design could affect the healing environment. The effort took off; nearly a hundred facilities contributed. “When I began in health care, there were about seventy-five published papers on the subject,” Parker says. “Now, there are thousands.”
Parker retired from Anshen + Allen in 2004, and stepped down from the board in 2009. The following January, he accepted an invitation to have lunch with Deepak Aatresh and Zigmund Rubel; Rubel was an architect who’d worked with Parker at Anshen + Allen for nearly ten years. Rubel had met Aatresh six months earlier, and was wildly enthusiastic about the sea change the former chip designer was proposing. But he also needed a reality check. Aatresh was nervous about meeting Parker. “I thought our idea would sound stupid to him,” Aatresh recalls. “Instead, he said he had never seen anything so fascinating in his life. And he asked how he could help.”
The Aditazz Way: An overview of how the software platform is set to revolutionize hospital design.
It wasn’t that Parker had grown bored with tending to his grandchildren and sailing in San Francisco Bay. But at close to 80 years of age, and after six decades of striving to create truly healing environments, he still felt the solution—and even the problem—was out of reach. Hospitals took too long to design and build. By the time they were finished they were already outdated. And while the delivery of health care—the science and technology behind the industry—made constant and significant advances, design and infrastructure continued to lag way behind. Cost overruns and schedule creep were common. Proactive value engineering was almost wholly absent—facilities were only evaluated after occupancy. He looked at other sectors—the cruise-ship industry in particular, where a vessel with 1,500 rooms, five restaurants, three swimming pools, and a complex propulsion and navigation system could be built on the water in four months—and he despaired.
“I’m glad we did all the work we did,” Parker says. “Evidence-based design. The Pebble Projects. The hospitals we designed. But I’ve come to the conclusion that it’s been totally inadequate. By the time we build something, it’s by definition suboptimal. I think we’re building the wrong things the wrong way.”
But even more importantly, she embraced the foundation myth behind Aditazz: Health-care architecture was stuck in the past and sorely needed a makeover. At Anshen + Allen, she’d seen projects drag on for decades, projects that consumed enormous blocks of time and energy as they morphed in form, function, and budget. The build-and-revise strategy may have been good for architecture firms, generating multiple rounds of design fees, but it wasn’t good for the client.
“In traditional architecture, you don’t move to the next phase until the client signs off on the previous phase,” says Romania-born Borkovi, now director at Aditazz. “As a result, documents can be seven or ten years old by the time you break ground. In the meantime, the director of pathology who wanted frozen sections on the second floor is no longer with the hospital, and that now that we have digital record keeping, the 5,000 square feet you allotted for medical records is a total waste.”
￼￼It was Borkovi who suggested that Aditazz enter the Small Hospital, Big Idea competition in February 2011, doggedly lobbying colleagues—including Parker and Aatresh— who didn’t believe the firm was ready. Four months later, Parker pulled the brick and computer chip out of his briefcase in the first of nine alphabetically ordered shortlist presentations in San Diego. Two days later, Parker and his colleagues learned they’d made it to the final three. In March 2012, Kaiser Permanente announced that Aditazz would share first place alongside a team from Mazzetti Nash Lipsey Burch and Perkins+Will NY.
Ultimately, the patient experience is at the heart of the Aditazz model. Above: Another rendering from the competition entry.
The British-Iraqi hospital designer—and self-described tech junkie—does believe computer modeling and simulation will eventually revolutionize hospital design. He’s a bit more skeptical that Aditazz will be the vanguard. Nor does he believe that a machine can be programmed to accommodate specific cultural parameters—like same-sex waiting areas in Saudi Arabian hospitals. “It’s easy to say we can put it into the algorithm,” Ayoub says. “But executing it will be another matter. There will always be someone asking for an exception—a doctor who says ‘I want this machine, or this configuration.’ And once you allow for one variable, everyone will ask for one. I do think we’ll get there eventually. We’re just not there yet.”
Guenther, the designer who led the Perkins+Will team that shared first prize with Aditazz in the Small Hospital, Big Idea competition, worries that design by algorithm will further erode the spaces where young architects can learn their trade. “Between current computer-aided design software and outsourcing, we’re already dealing with the wholesale loss of entry-level positions,” she says. “The methodologies for intern architects to learn the craft need to evolve. And this is even before we move to automation on steroids.”
The (shared) victory at the Small Hospital, Big Idea competition has brought validation—and an aura of legitimacy—to the three-and-a-half-year-old start-up. It has also brought some business. Aditazz is currently consulting with Kaiser Permanente on a series of emergency rooms. There is also an initial-stage hospital project with Stanford, and several feelers from abroad.
“India alone is short almost two million hospital beds,” says Ajit Singh, Aditazz CEO and a partner at Artiman Ventures, who won’t know whether his investment will pay off for at least ten years. “Our solution could be ideal for developing economies, enabling them to leapfrog existing technology into something that is cheaper and more efficient.”
These days, Aditazz company meetings are lively events, with specialists from myriad disciplines groping for a common design language as they slowly but surely populate their algorithm with parameters and data. (Given its international composition, the team at times gropes for a common language in conversation as well.) But every team member knows why he or she is there. And surprisingly, it’s not just to bring a recalcitrant industry into line. “Of course we’re interested in making Aditazz successful,” Singh says. “But throughout the process, the most vital considerations have come from Derek. While we focused on speeding up construction, he would ask about cutting the time a woman needs to wait for the results of a breast-cancer exam from three weeks to one day. When we worked to cut costs, he pushed to reduce the number of steps nurses had to walk each day. Without Derek, I think we might have lost sight of the fact that we weren’t just designing buildings. Fortunately, he’s there to remind us that we are building care.”