The design process for healthcare spaces is multi-layered, spanning months to years, and involving numerous stakeholders. Healthcare Project Manager Greg Salandi is the first to admit that there are many areas where it can be improved. It isn’t unheard of for there to be hiccups when bringing a project to life, however, in the case of medical spaces, having to repeatedly go back to the drawing board to accommodate new information, changes in stakeholders, or evolving technologies can delay the opening of a project and waste both time and money. For the Healthcare sector, specifically, challenges like this can diminish or delay the much-needed care that patients in our communities seek.

To explain the current design process, where issues arise, and what Ankrom Moisan is doing to streamline early design and improve the process of designing healthcare spaces, Greg and Healthcare Principal-in-Charge Hao Duong sat down to discuss efficiency concepts in the design of healthcare spaces for better overall project delivery.

Greg and Hao in Ankrom Moisan’s Seattle office.

Current Process

The current design process employed by Ankrom Moisan’s healthcare team (AMHC) begins with a “dance of coordination with client stakeholders and the design mechanical, electrical, and plumbing (MEP) consultants as it pertains to equipment in a given space,” according to Greg. Within this dance, architects are typically viewed as the instructor who leads the choreography that all parties, including vendors and technical specialists, come together and orient themselves around, ensuring everything jives together before initiating a transition to the next step.

The process begins with understanding everything from organizational drivers for a project, to budget and schedule, and eventually the details of where precisely to locate specific ports and receptacles. Options are often presented by the design team and in turn, design decisions are made in collaboration with stakeholders. Decisions typically build upon each other so it is important to avoid revisiting these choices later in the process, as they may affect other decisions and result in increased project costs and extended schedules. For example, an early decision to not accommodate individuals of size in a patient room can profoundly affect many aspects of the room if reversed at a later date. Room size increases, fixture and equipment revisions, redesigns of overhead infrastructure, additional structural elements, and door size revisions are among some of the immediate impacts of a seemingly small shift in direction like that.

Generally, project stakeholders will come to the table with specific goals: the patient demographic, the type of nursing unit, special equipment or services to be provided, bed counts. Sometimes those stakeholders have more subjective goals such as the creation of an inviting, home-like environment to put patients, family, and staff in a more relaxed mental state. For a lot of projects, combining technical requirements with more atmospheric elements is a challenge for the design team.

After defining the project goals, the programmatic ensemble – where things land within the space and how workflow will come together – comes next. This step entails deciding room formatting and purposes, as well as ensuring that all surrounding spaces are cohesive, and that their positioning makes sense for everyday use and workflow. The design team puts their best foot forward, creating drawings to illustrate the parts and pieces of the design, the rooms, the adjacencies, and the details that flow between those elements. A recent project for Greg and Hao involved a nursing unit at a local top-rated hospital that included typical nursing workspaces, nurse stations, clean and soiled rooms, and nutrition and hospital operations closets. This project also included 12 patient rooms that were to be completely demoed down to structure and built back to refinished space.

Example of the In-patient Wing portion of a programmatic layout.

The process of demolishing the two floors of the nursing unit down to the structure provided an opportunity to revisit all aspects of the design, adjacencies, and flow from a base level. The healthcare design team went through the process of redesigning the whole wing, meeting with the project team and client stakeholders to define the essential aspects of the project and establish guide rails to define their goals for the space. Since everything other than the structure itself was redone, the AMHC team took it as an opportunity to work on the nuances of each space within the larger unit, discussing the equipment and features needed in those spaces.

As healthcare teams move towards smaller details like the location of outlets or determining where nurse stations will go, they start “creating hardline plans and designating zones and elevations for where those things will be found,” explains Greg. An increasing amount of documentation is produced at this step, with an equally increasing amount of design effort and coordination spent to create them.

Up until this point, all design work, plans, interior elevations, renderings, and story boards have only occurred digitally. The design has not jumped into the real world. This point is important because not all project parties are versed in the reading of design documents or drawings. Often, a physical representation of the project space is needed for many to “see” the design.

Once the programmatic layout is decided upon, a mockup of the space is put together to share with users and stakeholders so they can ‘dance’ through the physical space and make overall adjustments to the design. This mockup can be basic or diagrammatic, as long as it represents each item that will appear in the final room format. Mockups can be cardboard, foam, or even real building products, with details represented by post-it notes and/or pictures of physical design elements. The project stakeholders and design team walk through the space to discuss and tweak those details. At the end of such a session, the design team is inched closer to reality and further documentation is created to record that status.

A patient headwall during a project space mockup.

Another element of this process that is unique to healthcare design is the many different types of equipment that need to be accommodated within these spaces. This is often a challenge in one way or another. Whether it involves replacing an old MRI machine or adding a new dialysis machine to a patient room, “there is always some nuance of the new equipment or required infrastructure that has changed over time,” claims Greg. “It never just plugs right in, and often the impacts behind the wall or floor or ceiling are not readily apparent.”

The required versatility of healthcare spaces and the differing technology requirements for those spaces necessitates more of the right people to be in the room to provide their thoughts on the given space’s design. “There’s a lot of technology with lots of requirements within a constrained environment which requires additional detail, additional organization, all that stuff,” says Hao. Having a wider range of end users in the space to provide their individual expertise during a design review ultimately results in a more well-informed project layout. “Everyone has a say,” Greg explains, “everyone has the ability to provide their input, because they have an inherent knowledge and expertise of what they do.” If we miss an opportunity to get the right people in a space to provide their feedback, it can open a door to additional setbacks for the project.

Greg and Hao reviewing a physical mock-up of a project layout.

The key players consulted in this process are all project stakeholders ranging from the primary client (e.g. owners or provider reps) to the facilities personnel and end-users (e.g. doctors, nurses, patients). Having a wide range of perspectives on how a space will be used helps the design team meet the needs of the final occupants and allows them to maximize the full use potential of a room.

Typically, once feedback on a design mockup has been received, the process begins again, starting by incorporating the new design suggestions and user needs provided by stakeholders. The design team continues to build upon their drawings and create further secondary documentation to illustrate the project design. Time and money go into these efforts every step of the way.

Project design diagram resulting from a mockup.

With stakeholder input, the design team begins the process of submittals and reviews with the authorities that have jurisdiction (AHJ), such as the Seattle Department of Health, for example. Most AHJs only want to know about certain required features, such as the number of outlets or receptacles, meaning that the space’s design can still be a work-in-progress at this stage since the actual layout really only matters to end-users and stakeholders. This can take weeks, if not several months, to work through. All the while, the design team builds upon the ever-growing stack of drawings to create a Bid Set for general contractors to provide bids, or a Construction Document if the general contractor is on the project team already. At this point, nearly 70% of the design team fee has been spent documenting – on paper – the designs created through the several iterations of meetings and review.

Process Challenges

There are challenges to this process, however.

Hao points out that challenges like “changes in frontline staff and leadership are fairly common in projects that take a year or more to complete. Each new person brings additional experiences and ideas that, if incorporated, may improve the design. But additional input from new individuals can have the adverse effect of creating more work or rework, increasing costs, and impacting the schedule.”

An example of this type of challenge occurred during a recent project that Greg and Hao worked on. At the stage of in-field box walks, facilities users and representatives for MEP operations showed up to participate in the physical review. As the first time seeing the result of the mockup drawings, MEP reps identified necessary adjustments to several features, including the dialysis box’s design and location, which requires specific types of plumbing accommodations to move. Since those facilities users had not seen the original mockup, the design team had to redesign the head wall to implement those requested changes, opening the floodgates for additional weeks and months of design adjustments and site visits. Multiple iterations of a physical install were required to gain approval from final facilities users and stakeholders.

Snapshots from a physical box walk.

This demonstrates the importance of physical vs. digital or diagrammatic representation, with Architecture and Engineering processes existing largely in the latter. Combined with stakeholders that don’t 100% “read” or “see” the drawings or grasp the impacts that those details influence in the final product, there is a larger chance for information to slip through the cracks, requiring later revisions or adjustments.

Greg used the example of a dialysis service box – an in-wall infrastructure connection point for a dialysis machine – to explain this idea further. “Actual in-field location comes later in the design/construction process, before the facilities users can actually see a tangible example. Alterations at that stage can change the whole headwall. Movements to the box location to accommodate behind-the-wall plumbing changes the flow of the bedside, and it changes all sorts of other stuff, also behind the wall.” This means that the traditional linear documentation process takes on yet another iteration of design as all the components are fit and re-fit into the final physical space.

A dialysis box headwall that has had location adjustments following the initial box walk. Note the two dialysis boxes side by side – the one on the left is ‘moved loc.’

Because hospital rooms have all kinds of ports and receptacles, especially at headwalls, for both patient and staff use of equipment, the largest aspect of the challenge in designing these spaces is ensuring that those ports and receptacles are in the correct and most opportune position for everyday use. Electrical outlets, medical gas outlets, low voltage data outlets, equipment rails, workstations, dialysis boxes, and even in-room furniture like chairs or the patient bed are intertwined in a dance with each other in this way. Adjusting one often entails adjusting the rest. The real issue arises, as noted above, when the location or adjacencies of these ports and receptacles are indicated on design drawings in ways that can’t be visualized or understood by critical stakeholders. This can lead to things being missed or overlooked during drawing reviews that remain undiscovered and unaddressed until the rough-in stage is complete and box walks are done in-person.

Additional challenges that can complicate and prolong the design/construction process include the rapid pace at which medical equipment or its interface with the built environment, as well as the hospital code or construction requirements for those pieces of equipment, advances and evolves. Greg summarizes the issue, stating how “certainly over time, codes can change, particular equipment can change, the technical requirements or even the detailing requirements desired by a facility – the lessons learned from real world installations – for some of those essential elements, can change. That change or request can impact a longer-duration project, as those code changes or equipment changes throw off progress that has been made.” During the long project timeline, requirement changes or stakeholder requests can necessitate document changes in the drawings and potentially in the AHJ process that is already spinning away.

Requested changes to detailing and installation for the dialysis service box itself (not just the location) can necessitate alterations to the documents and submittals that brought the project to this skeletonized, built form. AHJ submittals need adjustments that require dialog with reviewers and ultimate buy-off on the new final product or install. The stakeholders requested a more robust installation for their new dialysis boxes, and those improvements were made during the active construction period, rather than during previous design phases, and based on lessons learned from previous projects. In this particular case, a change to the dialysis service box placement and detailing extended the project schedule by over one month, triggering many meetings and incurring budget impacts in excess of $100K. Ultimately, the project’s go-live date was pushed out farther into the future than originally planned, resulting in concern and frustration by hospital leadership.

Both of the situations noted above influenced the project’s schedule and budget. Additional time and costs are added with every change to the previously drawn documents in the prior design phases.

“Even though the process is multi-layered, it’s never going to be perfect,” Greg admits. However, just because the process will never be perfect does not mean it isn’t worth improving.

Solutions

Greg and Hao identify a few solutions embraced by the industry that address the primary challenges of the typical design process, such as changing staff, changing equipment and code, and extended timelines and budgets, among others. The solutions they employ range from the ‘big room’ idea where everybody is collocated in the same place to discuss everything both big and small, to the ‘design workshop’ idea, where the design process is more like a sprint from start to finish within a set amount of time. Both solutions occur early in the design development phase with the goal of solidifying all the details, parts, and pieces of a project, setting those decisions in stone, not to be revisited.

“There are some things that have been tried by other firms that have not been considered standards, and then there are other things that have evolved standards but are not yet adopted,” Hao clarifies, indicating that there is no one-size-fits-all solution for the challenges faced by Ankrom Moisan’s healthcare team.

A lot of the proposed solutions are in no way new ideas for Ankrom Moisan. “It’s one of those things that has been there from the beginning of time, and we just keep trying to improve upon it and make tweaks to our process individually and as a team and as a firm that might differentiate us from others,” Greg explains. “Most solutions implemented follow a traditional design process timeline and cadence, meaning they are enacted early-on, before real, physical field work has been done on a project.”

Ultimately, Greg and Hao are trying to reorganize the early design documentation process to streamline the efforts of the project team and schedule, preventing re-work and safeguarding time and fees in the process.

In terms of making this a reality, the AMHC team intends to dedicate time and effort toward creating templated lists and details of requirements to be shared with stakeholders and end-users early in the design process. Having those templates on hand allows the project team to quickly vet those requirements for a given space with the stakeholders and end-users, and can therefore make headway on the design process for other spaces and areas of the project instead of focusing on the minutiae of the exact location of headwall ports and receptacles, for example.

As noted earlier, AHJs don’t necessarily need to know the exact location of a headwall element, and headwall elements don’t necessarily need to be drawn on the documentation. What the AHJs do want to see is that certain ports, receptacles, and quantities will be present at the project’s conclusion. The design and construction teams inevitably provide AHJs that information through inspections and record documents of those final locations. In this example, what Greg and Hao propose is diagrammatically designing the headwall for the purpose of stakeholder design intent sign-off and AHJ approval to begin construction, therefore continuing overall project cadence and momentum, moving those decisions and location changes from the drawn world into the physical. “We’re trying to prevent re-work by pushing those decisions into the built environment, which is more tangible to the everyday end-user than a set of technical drawings,” Greg reveals. The permitting documents can serve as a scaled-down design package that provides the necessary information for the AHJs initial approval for go-ahead into construction.

Once into the physical construction, the build and design teams produce the skeletonized headwall and can finally “see” locations and adjacencies. Project stakeholders and end-users typically participate in this review to “see” design solutions in a tangible form. After these reviews take place, the design drawings are finalized with the locations and dimensions of ports, receptacles, and equipment that will be provided to AHJs and submitted as a project record.

Final iteration of the diagrammatically-designed headwall assembled by Greg and Hao.

Solution Impacts

Greg summarized the impact of implementing these changes to the current healthcare design process, saying that it would be “an opportunity to get our arms completely around the large aspects of a project early on to ensure the linear design process keeps moving and advancing.” This is significant when trying to prevent backwards steps, as those backslides cost more time and money in the long run. “We’re always trying to have steps going forward so that every time we go to a new phase or the next step, the smaller details we incorporate build upon the existing design.”

Another positive impact of incorporating these changes is that projects can adhere to existing budgets and schedules without as many design iterations and backwards steps. “A lot of times with our clients, our stakeholders, they’re worried about getting a project open and operational to provide services as quickly as possible.”

Overall, a revision of current design processes to be more streamlined and efficient will have positive impacts on the design teams that create healthcare projects, as well as the owners, clients, stakeholders, and end users of those projects. It’s a win-win solution that establishes choreographed design and construction processes to secure the momentum and success of our healthcare work.

In the end, once the shuffle of design and detail coordination is over, these choreographer architects can lace up their shoes and begin participating in the dance of bringing their essential healthcare projects to completion.

Biophilia is the concept that there is an innate connection between humans and nature. Our love of nature and tendency to crave connections with the natural world is a deeply engrained and intuitive aspect of both human psychology and physiology. It’s part of our DNA.

Building off that concept, biophilic design is the intentional use of design elements that emulate sensations, features, and phenomena found in nature with the goal of elevating the built environment for the benefit of its end users.

Simply put, biophilic design is good design. It doesn’t have to be expensive or elaborate; it just has to be intentional. Creating connections to the outdoors in the built environment can significantly impact users’ mental and physical well-being.

How Biophilia is Integrated into Projects

There are many ways to integrate biophilic elements into a project’s design. Some of the most common methods of doing this have been categorized by the National Resources Defense Council (NRDC) as being either Nature in the Space, Natural Analogues, or the Nature of the Space.

1. Nature in the Space

Biophilic design that places emphasis on bringing elements of the outdoors into interior spaces would be classified as ‘Nature in the Space.’ These outdoor-elements-brought-inside can be anything from plants, animals, and water features, to specific scents, sensations (like the feeling of a breeze), shade and lighting effects, or other environmental components found in the natural world. They are organic features that are literally brought inside. An example of this could be a project using natural materials like exposed mass timber and green walls covered with living plants to mimic the sensation of being in a wooded forest.

2. Natural Analogues

‘Natural Analogues’ in biophilic design are human-made, synthetic patterns, shapes, colors, and other details that reference, represent, or mimic natural materials, markings, and objects without utilizing or incorporating those actual materials, markings, or objects. An example of a natural analogue might be the use of spiral patterns in a painted wall mural to link a project’s design to seashells and the coast, the inclusion of animal print motifs in fabric and material choices, or even the use of blue rugs and carpeting to link a site to a nearby river or other body of water. Subtle finishes, fixtures, and equipment (FF&E) touches can also be a biophilic natural analogue, like the use of shelves that reference the pattern and shape of a honeycomb. Natural analogues are most often design and material choices that pay homage to recognizable environmental elements.

3. Nature of the Space

A focus on the ‘Nature of the Space’ on the other hand, pays more attention to a location’s construction, layout, and scale than its FF&E and other accessories or interior design. It utilizes spatial differences, the geography of a space, and other elements of a project’s configuration to imitate expansive views, sensory input, or even feelings of safety and danger that are found in the wild. This may manifest as an open stairwell that embraces rough, asymmetrical walls to subtly mirror the textures of a canyon, or as the inclusion of an atrium to give end-users a perspective that parallels the wide-open views seen from a mountain peak. ‘Nature of the Space’ can also be seen in the use of soft lighting and smaller scale spaces to simulate the felt safety and coziness of a cave. It is the utilization of a project’s site itself to replicate experiences and sensations found in the world of nature.

By emulating natural features and bringing the outdoors in, architects and interior designers integrate the benefits of exposure to the natural world into built spaces, creating a unique shared experience for a site’s users.

A list of biophilic design elements and attributes. 

When combined with intentionality and thoughtful design, these elements can transform ordinary spaces into spaces that support human health and wellness.

The Power of Biophilia

Aside from elevating design, the inclusion of biophilic elements in a project can have numerous positive health benefits for those who use and inhabit that space. Biophilia’s impact on health and wellness may not be something that we are conscious of, but it is a difference that we feel. Humans understand biophilia intuitively.

The amount of time humans spend interacting with nature – as well as the amount of time they are disconnected from the natural world – has real, tangible impacts on an individual’s health. In today’s industrial, technologically dominated world, it’s especially important to seek out connections with nature, since many built spaces often forgo biophilic features and the benefits that come with them.

The negative health impacts of not having enough connection to nature are:

• High blood pressure
• Muscle tension
• Anxiety
• Poor sleep stemming from an unstable circadian rhythm
• A weakened immune system
• Poor focus
• Weak memory
• Attention issues like ADHD
• Fatigue
• Decreased emotional regulation

The positive benefits of exposure to nature, on the other hand, include:

• Lower blood pressure
• Muscle relaxation
• Feelings of safety
• Restful sleep and a stable circadian rhythm
• A strong immune system
• Increased focus
• Greater memory and learning abilities
• Higher energy levels
• Increased emotional regulation

Knowing the range of benefits that biophilia has the potential to provide, architects and interior designers have the opportunity to purposefully design spaces with the health and wellbeing of its end-users in mind, positively influencing the experience of a location as well as the feelings of the people occupying it.

Some of Ankrom Moisan’s expert design teams have already done this, including biophilic elements in the shared spaces of project to elevate the end-user’s experience of those environments. In a follow up blog post, we will take a deeper look at how biophilia shows up in three distinct Ankrom Moisan healthcare projects, discussing how the inclusion of biophilia can be leveraged to support an evidence-based approach to holistic, whole-person care.

Ankrom Moisan has offered feasibility studies as a service to existing and potential clients for decades. For those who are unfamiliar, a feasibility study helps assess the viability of a potential development on a particular property. It aims to help a real estate investor understand the future amount of revenue-generating area on a piece of land, and what a reasonable sales prices might be for that land.

Typically, the feasibility study process begins when a client, landowner, or broker reaches out to us. We usually start with a site analysis, to get an idea of the average unit size and parking ratio, and then conduct a ‘fit test.’ That fit test quickly and efficiently diagrams potential development outcomes that could be realized on the land parcel. When conducting a fit test, we look at the site’s zoning code, relevant building code, physical site characteristics, visible utilities, site context, and building typology constraints. These constraints are often related to building uses, building type, height and size, or the amount of parking required. For example, a housing-use structure has much different parameters than an office-use one. Further, a ‘Stick-Frame Wood’ building typology will yield something quite different than Cross Laminated Timber or Concrete.

Examples of a feasibility yield study.

If desired, we can go further and analyze architectural outcomes that consider preliminary ideas about building design and character. Sometimes, a client will provide their own constraints or parameters, like a more detailed unit type and amenity program. Renderings of varied detail may be added to this process to help visualize a proposed project idea; they are useful to illustrate the early-stage potential of development ideas to a wider audience.

Example of a Tier 2 Feasibility Study Perspective View.

We often provide our clients with multiple (and sometimes contrasting) design ideas. By discussing the advantages and drawbacks of each idea, we reach a point of mutual understanding with our clients and can begin to fine-tune their vision.

Animated early visioning sketch for a multifamily housing urban land parcel assessment.

It is all about leveraging future architectural solutions to effectively utilize what a site has to offer. We are constantly seeking improvement in this process and are regularly evaluating methods to do so. From a basic ‘back-of-the-napkin and a calculator’ approach to a deeper architectural examination informed by years of design experience, or even the use of Artificial Intelligence software that can automate metric evaluation of a site, we consider all possibilities and methods of maximizing a project’s design according to client desires and site parameters.

3D Massing Views and renderings conducted for a Tier Three feasibility study.

Through this process, we give clients, landowners, and brokers meaningful guidance towards the value of their land parcel. This process is especially helpful for people interested in working with Ankrom Moisan for the first time, as a feasibility study is an uncomplicated way for prospective clients to get to know us and learn how we work. It is a great opportunity to see if we work well together.

We have a vast resumé of work and pull from a wide range of past experiences with different building types – everything from tall to small, across a variety of uses (retail, hotel, office, hospitality, housing, etc.). We enjoy this work as it is an essential part of our process. We enjoy offering feasibility study services that share our expertise with longtime and prospective clients, landowners, and brokers alike, showing exactly why Ankrom Moisan is a valued design partner.

By Jason Roberts, Managing Design Principal, Bronson Graff, Associate Principal, and Jack Cochran, Marketing Coordinator.

Popularized because of their connection to nature and relative abundance of space, garden-style apartments are lower density, low-rise housing complexes that are typified by their green, garden-like surroundings. Through Ankrom Moisan’s experience designing high-quality low-density communities, we’ve found that successful garden-style design is all about striking a balance. There’s an art to creating a community that is highly livable and authentic, yet also efficient and economical. Based upon our expertise with this style of housing, here are our dos and don’ts for creating successful low-density garden-style communities.

Do capitalize on site assets.

Site plans are everything when it comes to designing unique low-density housing. Before any buildings are designed, take note of site features such as topography, open space, noteworthy views, and existing natural resources such as bodies of water or mature trees. Designing a site plan around these features elevates the design of a garden-style apartment community to be authentic to its location, setting the place apart as a destination with its own identity. For example, at Deveraux Glen the site plan intentionally takes advantage of the surrounding green space by orienting the buildings to maximize views. This is apparent in the irregular perimeter, shown below.

Deveraux Glen site plan | Aerial of a neighborhood by Erik Maclean

Do balance the parking. 

While parking yield is important, preserving the character of the place is also essential for success. This requires finding a careful balance. Because available parking ratio ultimately determines home yield, and not allowable density, parking drives (pun intended) everything. Efficient footprints like parking must be designed first, with buildings fitting into the site afterwards and conforming to the lot’s parameters based on the home plan. However, that does not mean the parking lot has to be the focal point for a site’s layout. Remember: nobody wants to live in a parking lot. A certain degree of intentionality is required to design a desirable community that has a sense of place and doesn’t just feel like an asphalt lot.

North Ogden masterplan | Garden-style development photo by Maahid

Don’t neglect landscaping.   

Use greenery to break up the humdrum of asphalt. Whenever possible, a space of 15 feet between parking and ground-level homes is ideal for garden-style, as it budgets 5 feet for the pedestrian sidewalk and 10 full feet for landscaping. There should also be landscaping between head-in parking stalls. 5 feet is the minimum amount of space recommended, but again, having more room for trees to be planted both screens the car park from above, and improves the quality of the space at ground level. Utilizing landscaping in this way improves the apartment’s sightlines and views for both the ground-floor homes that look towards the parking lot and the upper-story homes looking down on it. While covered parking may improve the visual landscape of a community, taking it a step further with green roofs or alternated landscaping does much more for both the environment and residents. The ultimate goal in garden-style design is to create a place that is as livable as possible to drive absorption, retention, and rent rates.

Club at the Park | Parking lot at The 206

Do consider walkability. 

Since garden-style home doors are exterior-facing, the outdoor experience must be carefully considered. Distances between frequently visited areas need to take walkability into account. Remote parking may allow for an increase in home yield but result in a reduction in rent rate. Designers should be very intentional with how far residents will have to walk to get from their cars to their front door, and vice versa. Parking allocation studies need to be done to assign parking stalls to certain buildings and determine whether or not distances and available parking options realistically work. Trash enclosures, too, need to be within a reasonable distance from residential homes and located along a route accessible to trash collection vehicles for removal. By putting forethought into residents’ travel patterns, designers can create a highly livable place.

Meridian Gardens rendering | Kitts Corner rendering

Do enhance ground-level homes.   

Ground level living is perhaps the most important design consideration for low density garden-style apartments. There are a handful of ways to enhance first-floor ground-level homes, the most effective being the inclusion of a stoop at the entrance. Stoops help create a sense of defensible space, and resident identity. Ground level homes also benefit from street elements. Streets are characterized by parallel parking and sidewalks, whereas parking lots are based on 90-degree parking, which means that light from cars in parking lots are angled directly into ground-level windows and the amount of land dedicated to the car is the greatest. Ground-level homes often receive the short end of the stick, so giving those homes extra thought can go a long way for improving the resident experience. 

Stoops at The Villas at Amberglen West | Ground-level porches at The Arbory

Don’t underestimate the importance of identity.   

Develop an encompassing identity for the entire community through a central amenity. As the heart of the place, the amenity building reinforces the character of the site. Surrounding spaces should support that identity through the quality and character of their architecture and interior design. Don’t shortchange design fees here; It’s better to spend up on the club house and economize elsewhere than to forgo the identity established by a central amenity. 

Clubhouse at Seasons Apartments and Farmington Reserve | Clubhouse at The 206

These guidelines are only a brief overview of some of the key principles to creating successful garden-style communities. There is a tremendous level of consideration of the specifics of a site when translating these principles into a successful design. What it all essentially comes down to is hiring an architect who understands these design principles and how to apply them to create efficient, high-quality communities. And of course, having beautifully maintained greenery doesn’t hurt, either.

By Don Sowieja, Principal-in-Charge

Revolutions in digital tools and technology are rapidly changing the landscape of many different industries across the globe. One of the latest innovations in digital technology is the widespread use of Artificial Intelligence, or AI. Two Ankrom Moisan architects, Michael Great and Ramin Rezvani – Director of Design Strategy and Senior Project Designer, respectively – have recently begun to incorporate AI software into their design process, receiving encouraging results.

Before the advent of Artificial Intelligence software, precedent images sourced from Pinterest or similar could be used to establish the initial aesthetic direction of a project. Because not every feature of an image would be relevant for a certain project, these images were often cropped and/or collaged together, leading to unnecessary confusion if clients became attached to specific features in precedent images that were never intended to be a part of the final design. AI-generated images have the potential to circumvent that issue, providing inspiration imagery that is specific to a particular place, project, client and design.

Example of an AI-generated precedent image.

Recently, Michael and Ramin have been using AI to create precedent imagery for their projects. In their experience, renderings created by AI software such as Midjourney assist in streamlining the design process and ensuring that clients are on the same page as designers when it comes to project design and direction.

For many, Artificial Intelligence still represents an enigmatic, complicated technology of the future, reserved for the plots of science fiction movies. However, recent developments in technology have made AI and its uses more widespread and accessible than ever. To explain how AI can be utilized to generate unique outcomes and facilitate a cohesive design language for a project, Michael and Ramin sat down to answer some questions about how Midjourney is integrated into the projects they work on and to dispel common misconceptions about the technology.

Michael and Ramin together in the Portland office.

Q: When did you begin incorporating AI into your approach to project design? Why was this something you decided to do?

Michael:

Our adoption of AI software has aligned with the technology’s continual improvement. Initially when we started experimenting with architectural imagery, it was giving us broad stroke building concept imagery. These were by no means a “design” but it got Ramin and I thinking, ‘Oh, this technology might be evolving to a place where we could utilize it more in the design process, let’s trial this a bit and see what we can get out of it.’

Part of my interest there is that historically architects have used precedent imagery to describe things that don’t exist yet, or to get clients aligned to what the design intent might be? Language doesn’t often get us to a full understanding. So, I think architects have always used imagery, whether that’s precedent imagery or rough sketches to just get alignment about the direction of a project aesthetically. Both Ramin and I have always thought it was strange that in this process you are often using existing buildings to convey new ideas. I think the advantage of using Midjourney and AI is that we can accomplish the same general task of conceptual alignment but show clients unique imagery that is specific to their project, place and aesthetic.

Ramin:

We just started playing around with Midjourney when it came out. It was really exciting and interesting, and we had no idea what it was, or what it could do, or how powerful it was the first couple of times we were testing it out. Then we tried to make it do something specific, and that’s where it started getting fascinating, because it’s potentially a huge shortcut for certain things- especially with generating concept imagery.

We kind of hit a wall with a project where we wanted to be able to quickly visually convey something that didn’t exist. We had some loose ideas influenced by some projects that only exist at a completely different scale than what we were looking at. We thought ‘let’s see if we can figure out how to combine all of these ideas and generate imagery to illustrate to the client where we are going with this.’ Through that process, getting imagery close to what we were trying to do was mind-blowing.

Final project design renders created by Michael and Ramin that were influenced by AI imagery.

Q: Ramin, you’ve said that AI is “like a paintbrush or any creative tool, you just need to figure out how to use it,” and Michael, that “it’s a language. You have to learn it, just like any software.” How did you both go about learning to use these tools, and how long did it take you to learn the language, so-to-speak?

Michael:

I don’t know how far we actually are on that journey, and I think we have a long way to go. There are a ton of resources out there, though, in terms of helping you learn the language through prompt editing. But this is moving so fast that there is now software that will do your prompts for you. You can just add in a few descriptive words, and it’ll fill in the rest, writing it in the way that the AI software wants to see it. Every time you use it, the more you use it, you learn something about what the output is. The more trial and error you go through, the faster you get at getting to an image you can use.

You have to think differently about the words you are using to get the imagery desired. It’s a shift in how you think since you have to use fewer words to get your idea across. You must be specific and pointed while still giving the software enough information. From that standpoint, I feel like the faster you can get your mind into that mode of thinking, the better off you will be as AI continues to develop, because the premise of utilizing language to direct output will only accelerate from here.

What we all have to adapt to and learn is how to use language to describe what we want machines to do. But even that is probably a couple years from being obsolete. There seems to be an updated version of Midjourney every month that’s substantially better than the last. Even since we last talked, they’ve come out with reverse-prompt capability. So instead of putting a text prompt and getting an image, you can do the opposite, dropping in an image and getting a prompt. By doing so you can start to understand the language in reverse because you’re dropping in an image and the AI is telling you what it sees in text.

Ramin:

I’ve been using it a lot, trying to figure out how to create very specific imagery. Like Michael said, it’s a lot of trial and error. To be able to get usable images, it has definitely required a shift in the way that I think due to the way that the prompts work. I’ve been approaching it almost like a science experiment, changing the prompts slightly with each iteration to see what I get back visually with each update. But also, it’s not like you can master it because it’s changing so rapidly. The next versions will likely have a completely different interface, so the way that you write prompts will likely change too.

Q: Can you walk me through the typical steps of using Midjourney to create precedent imagery?

Michael:

The process right now that we’ve been utilizing is that we’re trying to plug it in to an existing process. On a lot of our projects, we start by charette-ing and brainstorming, trying to develop a cohesive concept. AI software like Midjourney increases the speed at which we can reach solutions, because we’re not all going in different design directions.

What we’ve tried to do initially is take the guiding design principles for a project and feed those words into the AI to see what kind of visual representation it would create with our initial thoughts. So again, trying to accelerate the process a bit and get to visuals through words that we’ve already talked about or discussed to create alignment on design direction. As the technology evolves, there will be other ways for us to utilize it, maybe in final renderings, for instance. But right now, I think coming up with precedent imagery is the best use of it.

Visual breakdown of how guiding design principles and text prompts are used to generate new precedent imagery renderings with AI software.

Q: [You’ve] said that clients often don’t know what to make of design renderings when they learn that they were created by AI. What are some common misconceptions or misunderstandings about Artificial Intelligence that you’ve encountered since you began using it?

Michael:

The most common misconception that Ramin and I have run into is that the AI-created images are just precedent imagery pulled from the internet. You have to explain that it’s not a search engine, it’s not finding an existing image on the web. Often, I have to describe what it does in shorthand for people to understand it.

Ramin:

One of the things I noticed right away was people asking ‘doesn’t this take the creative process out of architecture now that you have this image designed by AI?’ At least for the time being, I don’t feel that way. As a design team, you still have to generate the foundational ideas and coax the AI to output something that aligns with your goals and vision. It’s a quick way to get the team on the same page and discover interesting emergent qualities from concept intersections that you may not have discovered on your own. In our current workflow AI produced visuals are intended to draw from and quickly study a whole bunch of different ideas to curate the most interesting aspects of each, based on what we asked the software to do.

Q: Do you have any fears surrounding the use of AI or the rate at which it is evolving, a la Terminator’s Skynet?

Michael:

Like any new technology, it absolutely has the ability to be used in various ways. I mean, there’s no way around that. I think there’s many applications of AI that could be negative, primarily in terms of its ability to manipulate people. But in terms of what we do, there’s not much risk if you understand it’s just one tool out of many that we can use. It’s not like Midjourney will actually produce architecture. It produces ideas that a designer still has to understand, edit, and synthesize into a project’s end design.

Ramin:

It’s hard to tell right now what is going to change and how much it will change. I’m definitely concerned about it, not just for the field of architecture, but for humans. In general, I feel like no technology has advanced this quickly before and it will continue to accelerate. There are just so many unknowns but I’m sure we will quickly see AI implementation in daily life. I think that we’ll know a lot more in the next five years or so.

AI process design results, highlighting the Midjourney-generated concept renderings that Michael and Ramin synthesized and incorporated into the initial massing render for a project.

Q: With the rapid speed at which AI changes and evolves, how do you envision the future of AI as it relates to architecture? What about the future of architecture as it relates to AI?

Michael:

I think that AI continues a theme that has remained consistent throughout the last 100 years in terms of how architecture utilizes technology. Usually, it’s used to speed up the design process. One thing about architecture that’s so different from a lot of other professions is that it still relies on artistry, but there’s always a ‘hurry-up’ type of attitude, we are often pushed to develop designs and drawings faster and faster because of project economics. So, we’re always looking for tools to speed up the process. In addition, architecture is a broad profession. There are people doing wildly different things in the profession their whole career, and I think that could get streamlined.

Outside of Midjourney, there’s a whole slew of AI implementations using other design and construction software that’s meant to speed up how fast we can produce a construction set with fewer people. I think inevitably, that’s where architecture has always gone. 100 years ago, it took 40 people in a room, drawing a set for a high-rise tower by hand. I think in the future, a 40-story tower can probably be designed and drawn by two people. Eventually, the industry will get to a point where one or two people can accomplish that same task in half the time it takes now.

I would say that right now, as designers, we are not spending enough time understanding the place, the people using the building, and the environment surrounding a project. We’re rushing through a lot of those elements to get projects built, so I think where you end up by incorporating AI into that process is more thoughtful buildings, because we don’t have to spend as much time crossing the T’s and dotting the I’s. We can actually think about the project and the building rather than drawing it, and to me, that’s pretty exciting. Architecture can’t do anything but get better through this process. I don’t think anything gets worse. It just gets better.

Ramin:

In my mind, there’s no doubt that any areas of inefficiency in the architectural process right now, some of which will be resolved using AI. It’s going to accelerate and amplify the amount that an individual can do by themselves, so I think it’ll take fewer people to do the same amount of work.

I think it will allow us to study way more aspects of a project quickly and, like Michael said, make projects significantly better by understanding more of the site’s parameters. It feels like an amplification to me now, but who knows what will happen in six months?

AI-rendered precedent imagery from other projects.

Compared to other Pacific Northwest architecture firms, Ankrom Moisan is a pacesetter in terms of integrating Artificial Intelligence and other digital tools. Few competitors use AI, if at all. International firms, though, tend to use AI software for design-based research. However you cut it, the digital tools of imagined sci-fi futures are closer than it seems, and may, in fact, already be here. It’s a massive paradigm shift that will take some time to get used to, but the good news is that when the AI overlords take over, we will already know how to deal with them.

By Jack Cochran, Marketing Coordinator

Does design have the power to enhance dignity?

Many of us have the privilege to go about our daily lives unaware of the powerful role the built environment plays in supporting our feeling of being celebrated and respected. As architects and designers, we must place inhabitants’ dignity at the forefront of our design priorities. Our work has the power to create spaces that have far reaching and lasting impacts. Few places need this perspective more than spaces that serve predominantly underserved, underrepresented, or socially stigmatized communities.

To start, what is dignity?

Dignity is the right of a person to be treated ethically as well as being valued and respected for who they are. For healthcare professionals dignified care means recognizing and honoring patients’ capacities and ambitions. While patient dignity is a core tenant of healthcare staff training, it is also critically important to consider the role of the built environment to support dignity for both patients and staff.

Dignity can be defined by four main factors:

1. Respect – Respect includes self-respect, respect for others, respect for peoples’ privacy, and confidentiality.
2. Autonomy – Autonomy includes having choices, being able to make decisions, rights, needs, and independence.
3. Empowerment – Empowerment includes feelings of being important and valuable, self-esteem or self-worth, and pride.
4. Communication – Communication includes clear information, language, intuitive wayfinding and directional cues, and privacy.

Here are five considerations for designing dignified environments:

Design as a Beacon

Too often, mental health and treatment program facilities exist in hidden spaces kept out of sight from the public. We aim to create spaces which bring a sense of pride to those who enter. By considering each step of the end-user experience, from the street approach to the quality of finishes, we aim to thoughtfully apply design aesthetics to create a welcoming facility from the very earliest interactions. Welcoming patients, clinicians, and the community into a space that is beautifully designed to support the specific needs and identity of the users is a meaningful way to communicate the intrinsic value of the patients and clients within those spaces.

In initial design discussions, Compass Health requested a sense of grandeur within their new facility located in Everett, Washington. After years of making do with an aging building, the goal for their Phase II building, housing both inpatient and outpatient behavioral healthcare, was to create a space that anyone would feel proud to enter. The stigma of mental health treatment was stripped away by prioritizing a grand, double-height entry and foyer that highlights exterior garden space. The exterior finishes were selected to be warm and welcoming.

Compass Health’s Phase II: The entry design uses scale, richly colored materials, and nature to evoke a warm welcome to all who enter.

The Power of Choice

In design, when we do not acknowledge the vast spectrum of human needs, we strip away the ability to exercise autonomy and control over our surroundings. Design that is mindful of autonomy, considers a variety of mental states, capabilities, traumas, and preferences to create dynamic spaces which allow people to choose the experience that fits their needs best in that moment. Avoiding the stress of being in an uncomfortable space allows patients and clients to receive care while in the best possible mindset. It also reduces negative associations that may become barriers for seeking care in the future. In many cases, mental health, housing, or medical facilities unintentionally strip away the opportunities for personal choice due to logistics and procedures, but thoughtful communication with providers allows designers to construct opportunities for choice and autonomy within even the highest acuity patient types.

The design team on the Alameda Senior Respite and Primary Care Facility acknowledged the importance of choice and autonomy in the design of the new 30,000 sq. ft. facility serving Alameda County in California. The design, which creates permanent supportive housing for an aging subset of the local homeless population, thoughtfully addresses the need for individual choice by completely rethinking the approach to lighting design throughout the building. Acknowledging the impact of harsh or bright lighting, uncomfortable lighting when resting, or a lack of lighting when trying to read and relax, the design team prioritized indirect lighting throughout all patient spaces, designed hallways outside of bedrooms to dim to the lowest levels allowed by code during quiet hours, and coordinated a wall sconce with controls at each bedside for residents. These simple, yet impactful, solutions allow residents to have autonomy over their surroundings in a way many of us would take for granted.

Safety over Security

We deserve to feel safe in our environments, and increasingly, facilities are moving towards providing a friendly face at entry points to help visitors feel welcome in lieu of uniformed security, which can be particularly traumatizing for many populations. Through collaboration with staff and clinicians, we can facilitate safety by designing clear pathways of visibility for observation and engagement that does not feel intrusive. Doing so allows visitors and residents to maintain their sense of independence and autonomy while remaining safe. Intentionally designed spaces which focus on relationship building increase the safety of patients while also increasing the likelihood of positive experiences and returns for subsequent care in the future.

The inpatient floors for Compass Health were laid out around a central nurse station allowing care teams to maintain a direct line of sight to all patient spaces, including the outdoor patient areas. Whereas other facilities require patients to be accompanied by a staff member to outdoor or group spaces, the clear paths of visibility allow patients to move from space to space unaccompanied, fostering independence while ensuring staff are aware of any interactions which may require their attention. Similarly, opportunities for passive observation in outpatient areas allow for easy circulation and a friendly face at various reception desks to assist first-time visitors and clients, as well as to foster connection with staff in various areas throughout the lobbies.

Compass Health Phase II: The building massing prioritized sightlines for the on-unit nursing and care team from the earliest diagrams (left). Interior design focused on maintaining the connection between staff and patients (right).

Whole Person Healing

If we consider the physical, mental, emotional, and social determinates of health in the design and programming process, we can create transformational facilities that help bolster the entire community. By creating space for additional programs and prominently locating basic needs near entries, each visitor can easily access support. Furthermore, designing medical care with counseling and housing opportunities provides a holistic approach to wellness that caters to a vast spectrum of needs, removing the barriers of care that occur when visiting many different facilities for the same services. Integrating community spaces into our designs allows additional social needs to be met that may not be related to specific medical needs, while inviting the community into spaces shared by diverse populations humanizes the experience of those seeking treatment in those spaces.

The core tenant of Central City Concern’s Blackburn Center is to “help people’s health through comfort, community, and safety.” The center, which serves people experiencing homelessness, poverty, and addiction in the Portland, Oregon area also aims to create a supportive housing project which incorporates mental and physical health resources under the same roof. The design carefully integrates a complex series of support systems that begin on the ground floor with commons area, teaching kitchen, pharmacy, and community services. Moving up a floor, the medical clinic supports the housing residents onsite. Housing includes palliative care, two floors of single room occupancy housing, and a floor of apartments for permanent housing, which supports people nearly ready to live on their own. The design aesthetics and function aim to create a fulfilling and enriching home-like experience that bolsters residents in all aspects of health and wellness, truly treating the whole person.

Nature as Medicine

Biophilia states that we, as humans, are part of nature and are inherently attracted to, and supported by, natural environments. Using nature as a tool to promote healing and wellness is a key part of providing users with the respect and dignity they deserve. Many at-risk populations receive care and housing in aging spaces that do not receive quality daylight, and access to outdoors is deemed too unsafe and difficult to monitor. By incorporating nature connections such as views, natural materials, fresh air, and plants into the requirements for healing spaces, we ultimately acknowledge the humanity of the occupants within a space. Whether they are patients, residents, visitors, or staff, everybody benefits from contact with nature through positive distractions, lowered blood pressure, increased resilience to environmental stressors, and the benefit of aligning our sense of time and place with the observable natural rhythms of the world around us.

Early on in Compass Health’s design process, the importance of fresh air and contact with nature was identified by the client and design team. As a result, the earliest building massing schemes explored how to bring nature as far into the building as possible. The resulting form for the inpatient floors is two separate wings positioned beside deeply cut rooftop gardens with a central connection space that serves as the primary gathering and dining area for the inpatient population. Each of the two floors of inpatient treatment have access to dedicated outdoor garden spaces that are designed to allow residents to move freely between interior living spaces and outdoor areas. Beyond the patient outdoor spaces are extensive green roofs which are visible from interior spaces in the public, staff, and patient spaces. This impactful design decision will support the healing and restorative vision of Compass Health’s mission to treat the whole person.

Compass Health Phase II: Both inpatient floors provide residents, staff, and visitors views of nature by utilizing the space between buildings for extensive green roofs.

Why design for dignity?

By implementing these five strategies, designers can create spaces that honor the core aspects of dignity by respecting each visitor and their unique place in the world, supporting their autonomy through choice, empower occupants as they move through the space, and ultimately communicate equitably inhabitants. The resulting designs are spaces which can be as meaningful as they are beautiful while actively participating in the health and growth of our communities.

By Ashlee Washington, Senior Associate

Every year, around this time, we gather as a firm and celebrate design. It’s like an Ankrom Moisan holiday. A week-long tradition we’ve all come to know and love—AM Design Week.

This year’s theme was aptly labeled “Better Together.” And the mission was simple: share, have fun, be yourself, and embrace change.

Opportunities to join in workshops, collaborative exercises and group discussions were sprinkled throughout the week so that AM staff could connect, share ideas, and improve each other’s work.

Some of us gathered over Zoom for an origami workshop hosted by an instructor in Japan, others participated in a guided collaboration exercise, or joined in one of the many happy hours—on a rooftop in Portland, in a Seattle speakeasy, or at a San Francisco tapas bar. There were neighborhood walkabouts, design critiques, interactive collages, and so much more. In fact, there were more than 15 activities organized across our three offices.

After the week was over, Kerstyn—AM Content Coordinator—told us that “as a fully remote employee, the opportunity to connect playfully with others at AM was welcome and offered many moments of creativity to look forward to.”

And it really was FUN! Perhaps the best way to illustrate just how much we laughed during Design Week (besides showing you the pictures) is to share a few of the fan favorite “proverbs” we collaboratively generated during our AArdvark Design Labs workshops:

“Sometimes people have ideas from the brain that transcend time and wavelengths.”

“Don’t forget to remember how a dog sees the bathroom before eating.”

“The AArdvark workshop was entertaining and illuminating, with back-and-forth between small groups, focusing together on rapid-fire improvisation” Kerstyn added. “Design Week was a treasure-trove of connection, conversation, and collaboration.”

by Mackenzie Gilstrap, Sr. Marketing Coordinator