How Physical Space Shapes Patient Experience, Brand, and Performance

Stewart Gandolf (Healthcare Success): Welcome to the Healthcare Success Podcast. Today I am pleased to have as my guest Larissa McAllister. She's president of Enviah.  Welcome Larissa.

Lorissa MacAllister, PhD (Enviah): Thank you so much, Stewart.

Stewart Gandolf (Healthcare Success): Glad to have you today. So people that know me well know that I'm fascinated by many things like shiny lights, LED lights, music, human psychology, mostly shiny lights, just teasing. But one of the things I'm very interested in is  design and spaces and the places people live or people work.

And so when  I was introduced to you, I thought this could be a really intriguing concept because  physical space matters much more than we give a sense to. So Lorissa, you're an expert on this topic and before I get into anything else, you know, just tell us when we're talking about today a built environment or a build environment, what are you really talking about and why would people in healthcare care?

Lorissa MacAllister, PhD (Enviah): Yes, thanks so much, Stewart. So the built environment is really the four walls of which care happens within. And so it's much around where care is delivered and where care happens. So it can be also where the staff are working, from where the patient is being receiving that care. It's the physical spaces of where that care is happening that we're talking about. We spend 90% of our time inside. And so that internal space, especially in healthcare, is very, very important.

Stewart Gandolf (Healthcare Success): So it's and I remember you have a fascinating background as a medical social worker, architect, researcher, author. That's a lot of different points of view on something that seems so obvious. Like we're just looking at a building.

And it is funny, as we're speaking here at this moment, I'm at our vacation rental in Palm Springs, which is very different than where I usually record my podcast at home, and it's a completely different environment. And it does matter. Like it matters how you think, it matters how you act, not just because it's beautiful outside and sunny. But the space is much smaller and it's much noisier here. And the floors are  polished concrete here.

So all these things matter in ways that I think may not be obvious. And in healthcare, the stakes are obviously much, much bigger. And so if you're ever thinking about your facility as just the building, I hope this changes your mind.

So  let's talk about this  connecting the dots here. Like how did you go from such a different sort of space? Like what made you connect the thoughts between the physical space and healthcare outcomes specifically?

Lorissa MacAllister, PhD (Enviah): Yes. Yeah. So  Stewart, my career started as a medical social worker and I worked in the built in the building and as we talked about, what is the building environment? I worked in the clinic, worked in emergency departments and found that the spaces that I was meeting my patients in, I would get different reactions. So if I had a crucial conversation in a hallway, I would get a much different reaction than if I were having that same crucial conversation in a appropriate consult room. I was able to  meet the patient or their loved one where they were, have good conversation, they would understand and hear my hear my information.

And so I started to explore changing spaces to have those conversations or changing  environments to be able to kind of think through and help meet them where they were and realized very quickly that healthcare there's limited space. So consult rooms get gobbled up into transforming them into other clinics, but it's not really honored as much as a clinical practice room.

And so I explored then architecture to understand why architects designed the spaces that they did and why they decided to have a consult room or not have a consult room and practice as an architect for quite some time, but realized that as an architect, and I am a licensed architect,  architects are in the business to build space. They aren't in the business to make spaces more effective or more efficient or more appropriate for the patient experience or the staff engagement.

And so really, then after I left that field and started my own consulting firm 16 years ago and really explored the science of how building spaces impacts behaviors, impacts cultures, impacts  an organization's brand especially. So if you want a brand experience, for example, you want to have a repeated pattern that happens over and over again, those examples of, you know, how do you create spaces that have that same experience is really important.

So that's really been my journey and it kind of comes full circle because I'm really still trying to support an environment that supports all people, but that I really still  providing the resources and tools to clinicians to do their work.

Stewart Gandolf (Healthcare Success): So that's such an intriguing insight. And I immediately flashed back in time and I've spoken on patient experience at multiple venues and multiple occasions. And I actually, one of the stories that I used in speaking about this, particularly back, I was fortunate enough to be invited a couple of times to speak at Cleveland Clinics Patient Experience Summit. And I one of the anecdotes I talked about there was my mother, when she was in her 90s, not this ever happened to any other 90-year-old ladies, fell and broke her hip. And so I remember being in the exam room with when they came and gave her the news that she likely had a broken hip, but they didn't have any place to put her. So she was wheeled out on the gurney, like or or the in the hospital bed rolled straight out to the in line with other people waiting for radiology. So I understand it's and it's I understand they probably didn't have space to put her.

Lorissa MacAllister, PhD (Enviah): Mm-hmm.

Stewart Gandolf (Healthcare Success): I understand that it was probably very efficient from the hospital's point of view, but from a patient experience point of view, where you're sitting there in a cold, cold hallway with people racing by you, and you're 90, that's a very scary moment, right? And so the space matters a lot. And I never thought about the fact that nobody, you know, until now really made the connection that people, I remember the experience part, but the design part was this thing, right? Like

So they're probably, you know, and again, I understand there's limitations that maybe it was a bad day for radiology. I get it. Hospital and healthcare is hard. But still, from a ninety-four-year-old mother's point of view, that wasn't a great experience. And so the the insight that, you know, her experience there would be so different in the way she would process information versus being in a proper room, is pretty amazing. So, you know, I talked about my own mother, but beyond my mom, who's passed away now.

You know, why should healthcare leaders care about this?

Lorissa MacAllister, PhD (Enviah): Right. Well, I think that I mean their space, especially today, you know, costs of our reimbursement rates and the cost for care is is dwindling down. The space that you deliver care needs to generate revenue. I mean, they're in we're all in business to generate as much generate the revenue you can with the space that you have. and more than likely the spaces that you have are underperforming for where you need.

And so I think what we see a lot of times and the hope that I have here that we can share today is that the leaders can they have the tools at hand for them. They don't need to go to an architect necessarily to get those answers. They have the means within their system to be able to anal analyze and assess.

So back to your  comment about your your your mother that was had a broken hip, to be able to look at that operationally to be able to understand, okay, if the radiology department is backed up, where are patients held, right? That are safely held and how do you create environments that support a more easeful transition from one location to the other and allows for them to be placed in a proper location. So maybe it's retooling a storage room or retooling or waiting room to allow for that to happen safely and supported, that those are elements that really could be empowered by the leaders to be able to recognize that their space is a a critical tool to support the perceived experience and care of what they've been of what the patient is receiving.

Stewart Gandolf (Healthcare Success): So what's interesting, I just did another podcast interview this morning. The challenges with these kinds of things is they're long-term important, but short term, I've got this person screaming at me, I've got this project I have to do, I have this or that. How has it been challenging for you to get attention when you're working with healthcare leaders to pay attention to this topic? Because it feels one of those, you know, if you remember the Urgent, not urgent, important, not important. This is in the very important but not necessarily urgent category. How do you get people to care?

Lorissa MacAllister, PhD (Enviah): Well, again, it more highly tied to revenue, specifically on patient experience, that shift has changed significantly. So my initial research and I continue to do research with multitude of healthcare systems and hospitals around coding rooms to the patient experience scores to the room of discharge. So looking at inpatient rooms and how those specific rooms are laid out actually directly impact the perception of care.

So an example would be orientation of a hand wash sink in an inpatient room. When you actually can look at that patient and wash your hands, the skill of the physician increased by 26% top box score. And so that's real data, that's real insights. That's not just retooling or scripting your clinician to be able or your physician to greet them more appropriately. It's thinking about okay, if I walk in and I have to turn my head to you, you feel that I'm not maybe skilled and so the perception completely changes.

And so the environment is a miss is really a tool, I believe, that leaders aren't thinking about in a way that they can really elevate their overall performance. Back to your mother that fell, and there's a lot of research that we have done in our team has done in regards to visibility into rooms. So if you have a low visibility into a room, the likelihood of falls increases significantly. So just even the subtle ways of laying out an environment impacts not only the potential for errors or the or as well as the potential for outcomes specifically for patient satisfaction and other components. So it really is a necessary tool that I think most leaders and more leaders are going to have to take into effect, especially as costs continue to shrink, and the potential opportunity for the needing of capacity, staffing levels, all of those things that needs to be thought of in the planning and design and the strategy of the overall system.

Stewart Gandolf (Healthcare Success): So this is a topic that I don't remember hearing about before ever, and I'm pretty, you know, immersed in healthcare. So I gotta guess with a lot of these hospitals were designed, you know, in the fifties or before, that they're just wrong. Is that true? Like compared to how care is delivered today?

Lorissa MacAllister, PhD (Enviah): Mm-hmm., completely I don't I wouldn't say wrong, Stewart, but I would say that the intentionality of the care delivery process is much different than in the fifties, right? And so much of the hospital facilities and chassis are in a Hilberton model, very structured walls, hard systems. And so it doesn't have the flexibility and adaptability that we allow for today.

But and we're seeing and even with the onset of AI and the reduction of staffing workforces, thinking about more open plans. So one of the things that we do a lot is the visibility look visibility analysis that looks at how the physical space, how connected is the space. So can I as a staff member see my colleague down the hall and to be able to feel as though I'm supported if I needed help? Right. And so these older facilities may be more cavernous and I don't have visibility to a colleague that could help me to support a patient in their care. 

And so those aspects of removing some of those hard walls and opening up the plan to allow for those coordinations to happen, as well as care navigation. So we do a lot of analysis on wayfinding, huge opportunity to help a person navigate through the facility. And I would strongly suggest your guests to just take one of your primary functions of patient pathways that your patients come in, start in the parking deck and walk the path of the patient  and see what they see. And can you navigate appropriately through the facility to the point of even  recognizing how things are signed. So one of the patient experience outcomes that we did with a client was just even following again that pathway, you see radiology, as you were talking, right? And then you'll see MRI and you'll see CT scan and then radiology again.

And you know, a person that's coming for an appointment to get an MRI, they see radiology. They don't know what radiology is. They might they have no idea. They just know they're getting an MRI. But so how do you properly sign in the pathway that you want them to take so they can navigate appropriately and find their way and not be frustrated in the process.

So again, the environment is the container where care happens. And if it's not strategically aligned with the operational outcomes that you're looking for, it won't ever perform. Your team will be deficient in their capabilities, the effort it will take to help navigate that person through that space because they're gonna ask one of the staff members, how do I get here? And then they're gonna be disrupted and then they'll have to continue to navigate them through the system. So it's a necessary thing that all health leaders need to really be thinking about,  especi specifically navigation and entry into their facility.

Stewart Gandolf (Healthcare Success): Great. That totally makes sense. I've got some comments and questions I want to raise later about some of these issues. But for now, let's talk you brought up money and I think that's really an important thought. In healthcare, you know, while the vast, vast majority of people I know are in healthcare because they wanna be. They want they have a mission, they wanna help people. The money is always a part of it, right? Especially in the United States where most of our listeners are working and listening.

The idea that a facility is a cost center, you're coming up with a radically different thought. Instead of the sun is ro rotating around the earth, the earth is rotating around or the the sun the earth is running rotating around the sun, meaning that is this really a performance driver versus a cost center? Help me understand. And how does that show up in real numbers?

Lorissa MacAllister, PhD (Enviah): Yeah, so great question. And I would say I one of the primary examples that I love to say is right now it's seen as a cost center and I believe we need to shift it into a revenue generation opportunity. And so right now it typically a healthcare facility falls below the line of saying, Okay, well, this is a necessary evil. We have to have a building to do our work. But really it could be a benefit because you've seen other facilities where that you know you have people that will come in and have glowing scores, why those experiences are that way. 

But how much revenue can you generate within that space is really important. So we're we're seeing a lot of health systems now looking at revenue per square foot or RVU per square foot. And what we've found is when you have a really tightly operated operation with a physical space, we actually can do what we've been able to do is an example project is patient  outpatient therapy gym that we took two different locations, we combined them into one location, it was the same square footage. So we weren't adding any additional square feet, but because we were aligning within operations and consolidating the staff, we were able to double the productivity, triple the revenue of that square footage as well as increase the top box score of likelihood to recommend by 8%.

So when it's all working together, people have less effort that they need to and and  to to offer the care. Staff doesn't have to work as hard because it's all kind of seamless within their reach. And then also the staff, the patients feel cared for, they're able to engage. And we know there's a direct correlation between staff engagement and staff satisfaction and patient experience and patient outcomes. So when those work together, the increase of the overall value of the system goes up. And so that you can get more out of both the staff as well as the space. So they really work in concert together.

Stewart Gandolf (Healthcare Success): So when we talked before, one of the things that got me really intrigued because I just I love counterintuitive things. And I can just imagine you telling a CEO, “No, don't make it don't get a new building. You already have the space you need.” Like that must be a moment for some of them. Talk about that a little bit. I'd love to hear like, wait, you don't need more space some necessarily?

Lorissa MacAllister, PhD (Enviah): Mm-hmm. Yes. Yes, more than more than likely you probably don't need more space. So we were just talking this this afternoon with my staff and my team. We were talking about just even staffing models. So if you think about if I have a staffing model of five to one ratio and I have an inpatient unit that I'm looking to accommodate or support or a clinic, and I have designed 40 rooms and I only have a certain number of clinicians or staff members that can fit into those spaces, we don't you don't necessarily are you're not using all of them. So they are operationalizing maybe 35 rooms, the capacity goes down, they're not able to to provide that.

On the flip side, if you're designing new facility, so say said facility you have a volume of a certain amount of patients that you're trying to see. And typically an architect will say, okay, well I need my shopping list of this many rooms, this much, this much support space and  exam rooms and offices. But then when you shift it to okay, building that environment, we find that 30% about is overbuilt because when you actually get into the operations of it, they're sitting in the rooms.

For example, the patients would be sitting in the rooms if you're looking at the delay that's happening within waiting for labs to be ordered and things. So that pushes a delay. So if you have a patient clinic exam room that's 60 minutes that you schedule, but then the lab you're waiting on or radiology you're waiting on, as you mentioned, that pushes that that visit time longer, that creates a higher demand for those rooms. So if you can improve your operational efficiencies, you can move the patient through that room more quickly and that gives you more capacity within your system.

Stewart Gandolf (Healthcare Success): So when you, going back to your satisfaction discussion you had earlier, do you you know again, healthcare marketing, I get to talk to a lot of healthcare marketing people within a health system and it's not an easy job. “Where is my billboard?” Right? They have a lot of that's it's an inside joke in the industry. They have a lot of competing priorities. But you know, from a marketing standpoint, do you feel like the health systems are underestimating the impact on their brand? This physical space is having.

Lorissa MacAllister, PhD (Enviah): Yes, for sure. I think again we've helped a lot of health systems again build their own personal brand experience. So again, coming from that perception of okay, what are your primary pathways that your patients are taking and what are those and we use Daniel Kahneman's peak end rule as one of the components of how we determine the behavior of science behind  those experiences.

So if you're mapping a full patient pathway experience, they park in the garage, they're gonna enter the facility. If you start at the at the peak, which is kind of where they might check in or they might  come into the patient room, what is that experience? How do they navigate to those locations? And then how do they exit?

So what's happening at the conclusion of that visit and how, you know did they have to wait a long time for valet to get the car or how are you can communicating how to get that  car from the location and can you see even just a simple thing of “where do I wait if I'm waiting for somebody to pick me up?” A lot of times when you're in a health system there's not any there's such a small vestibule area or there's no waiting area or seats by the window so you can see whether it's somebody coming to pick them up and a Lyft or if they're just coming and and picked up by a bus, that to be able to just sit outside or sit in a secured area that at the end of a visit can really determine someone's perception of care and their experience at that location.

So again, our view is really looking at a full experience of how that patient is going through the facility. And then also we look at the staff side and ensuring that the staff, you know, thinking about okay, where is the staff parking? Where is the staff entering? Where is the staff checking in or punching in if there's a time clock or entering it into a computer? Where do they take a break? How far is the break area from their work area? And really thinking about the distances people will have to travel in their full shift and making sure that they have respite spaces to support them so that their care that they're delivering can be supportive. So access to outside, a lot of staff rooms aren't on the exterior walls of facilities. And so, you know, they never see daylight until they leave in the middle of the night. And so looking at opportunities to really enhance that experience on the staff side is really important as well. So it's both patient focused as well as staff focused.

Stewart Gandolf (Healthcare Success): So I thought it was interesting you brought up the peak end rule, which I I've heard of the recency frequency effect, which is the idea that whatever the most recent see in frequency. I've also heard about the effect of people's perception based upon whatever the the primary thing was in the very end. So we have that. And the peak end rule is a little bit different, their peak of their experience and then the final experience. So these are the kinds of concepts that I think are intriguing and things that I remember learning about many years ago. But like how can organizations, you know, remember these concepts and intentionally design their space so they, you know, strengthen the brand perception, economics, brand patient loyalty and all those things?

Lorissa MacAllister, PhD (Enviah): Mm-hmm. So when you have multiple locations, the brand experience needs to be repeatable, right? And the same experience happens even though you're gonna have different staff leading those facilities. So again, what is the welcome experience greeting happening?

An example, a project that we did with a cancer center, one of the components that they wanted to emulate as a brand standard was the inspiration and the hope of survivors. And so one of the critical components of that brand was to see survivors volunteering and supporting as you entered into the facility. So creating an entry experience where they were feeling welcomed, they were greeted physically by a person that was a survivor of cancer and they had support spaces for those cancer survivors to, you know, have a break right off the entry of that facility.

So thinking about those brand experiences and creating environments that would support and allow for that person to stand, be welcomed, greet the welcome people. And so that that would be repeated location after location and that would become the marquee of that experience and understanding. So we create very clear brand standards, whether it's hope, whether it's inspiration, another client we have been working with, inspiration as a rehab facility, they wanted to be inspired. And so throughout the facility, as part of their brand experience, was seeing others achieve their accomplishments on a daily basis. So therapy happens in the hallway. It the gyms have large windows, so you can see people accomplishing their goals on a regular basis. And so that inspires others to come and it creates an environment and it creates a brand identity that really creates an evokes that idea of inspiration and emulates throughout the brand. So I think that without the physical environment that supports an initiative of a value or brand experience, i it doesn't stay. It won't sustain because it it doesn't just live in a person. It lives within the spaces in the four walls of the facility.

Stewart Gandolf (Healthcare Success): So some quick comments on the multi-location aspect of this. We do a lot with this. I just interviewed the CEO of a 650-location dental business. It's the same thing, right? There's a lot of space planning there. And you know, a lot of times when you're doing a business like that, you're acquiring  businesses that already exist. So you can't change everything right away. Probably, practically is very difficult. But you could at least have a model of what your brand experience should look like and figure out where the delta is where you where you want to be and where you need to go and at least plan that in as you're rebuilding or moving or whatever. Cause there's a lot there.

And that I I love that you brought that up because we think about this a lot when we're working with multi location providers in any specialty. The brand experience is one of the big challenges is if you're especially if you're acquiring, everybody has their own culture at a l local practice level. They have their own layout, they're doing things, but that's not where you get efficiencies of scale. It's not where you get things you can control. It's just, you know, it's a sea of little mini states, not part of an exact, you know, the same country even. So I think that's really important.

These ideas are fascinating where you start taking things like, okay, we know we want a consistent brand, we know we want to scale operations, but most people aren't thinking about the building itself. So I guess that's my mini insight off of like where you're coming from.

So, you know, given this what we're talking about, and you know, we work in addiction too, by the way. So I'd love to hear a real world example where something was really an exciting, led to measurable improvements, satisfaction, revenue, throughput or whatever.

Lorissa MacAllister, PhD (Enviah): Yes. So back to I just wanna answer your question or kind of make an additional comment in regards to the multi l location with limited monies because I think a lot of times what happens most of folks will say, “Okay, well I just don't have the cash, I don't have the revenue to be able to spend to get this all the same.” And it's not that you have to remove, like you said, the you know, 1950s building whatever, but if you identify again those peak and their specific components of the care delivery process that are very important that become kind of your marquee brand experience.

So if you look at, for example, Mayo Clinic had their clinic bench in their in their exam rooms, right? The bench became that experience that all the family can come and sit on this bench in the exam room. That became kind of an understanding of that experience. So being able to say, okay, maybe it's just the clinical care space or again, aspects of feeling welcomed or wanting to be able to incur kind of within those frameworks to say maybe two or three that you roll out to the larger facility, but you could you can isolate them and then build them in with research and evidence to be able to support those behaviors and that experience and understanding.

So my guidance to you would you don't need to you paint everything the same would help but it's just those experiences that this is the same everywhere, that I'm able to  sit in a certain chair or sit in have a relationship with folks.

We worked with Dow Chemical Company for years in regards to their occupational health facilities where they rolled it out globally and their primary function was their consult room and just repurposing their consult kind of exam room that went out through all the world  that they just patterned that one component and repeated that on a on a regular basis. So that would be something that you could look at and again not having to redo everything.

So back to a marquee project with outcomes specifically, an example kind of back to that  initial entry of a facility again at a rehab facility, we looked at the check-in function. And to be able to check a patient into the front desk, what if you're newly in a wheelchair or in a walker, it's very hard to navigate a standard desk. kind of check-in or even a chair. And so we made open pod kiosks for them to navigate into and had the check-in function happen in those open pods that allowed for the check-in tech to be able to come across and have those conversations with them and again to be able to really meet that patient where they were and increased the potential or the the patient experience outcomes for that location up to they were at the 70th percentile, they went up to the 90th percentile,  just with some of those initial additions  at the at the front end of that  facility.

Stewart Gandolf (Healthcare Success): That's great. So you know, I've got my own ideas and from this conversation. There's been some keywords I heard in the middle, but I'd love you to summarize. Like if you have somebody listening in, thinking about they've got a facility, it's you get what you get, right? And you don't throw whatever these moms used to say. So the you've got a facility, you can't build a new one. What are some of the biggest opportunities for quick wins on an existing space?

Lorissa MacAllister, PhD (Enviah): Right. I think the big the big quick win I would give you is kind of through the patient's eyes, we call it. So walking through the patient's eyes of how they would navigate into that facility and feel from their perspective what they might see and to be able to craft what is actually happening with something new and then also I think listening to the staff, most of the staff have some ideas and concepts of what needs to happen to make their care delivery opportunities better or others. And so really taking that time to do that.

And then the third would be is what are we truly trying to emulate as a a feeling or a brand standard within their facility? What are the values that we're trying to convey? Being able to understand what that is and as as I mentioned, whether it's hope, whether it's inspiration, and then how do you define that you've achieved that? How do you know you've arrived? And how  dignity is another one that we've talked a lot about. And so what does that mean to have a dignity in a cancer center means that they have access to a toilet room very easily or things of that nature. So thinking through what are you trying to achieve, what's the patient experience, and you know, listening to the staff and and recognizing that they have some great insight on how to deliver better care.

Stewart Gandolf (Healthcare Success): So I want to go back, I appreciate that, and all those things sound very important. When you talked about open openness in space and the staff being able to see each other and patients being able to see, I have to giggle a little bit. My wife and I, when we were looking for a house, it's like, let me guess that everybody wants or you know, you're or the realtor is like, everybody wants an open floor plan. Really? That's such a surprise.

So in residential architecture, that became a thing. And you know, a lot of any building that's older, a lot of times they're sort of rat's nests, right? They added rooms and they added more rooms and they added more rooms and there's no real thought of how those rooms all work together.

But is that a key area of like looking at how to open spaces? You mentioned wayfinding as well. So just sort of tactically speaking, some of the things are levers that you want to pull often.

Lorissa MacAllister, PhD (Enviah): Yeah, so I wouldn't say that  necessarily all healthcare spaces need to be open. I think they need to be con they need to be orchestrated around the system of care that you're providing. So if like for example, if you have a clinic pod and you're just looking at the pod specifically, where are the staff members charting and working and then where they might, you know, and again with technology and AI, if they're doing remote conferences or where do they have to go from that location? So I think that, you know, sometimes you want quieter, you know, contained areas. So I wouldn't say necessarily all blanket spaces. Yeah. Yeah.

Stewart Gandolf (Healthcare Success): Sure. I I hope I didn't give that impression. I was just saying it but there are areas that make sense or th or not. And also sanitation you can't have open when you're trying to control all the germs flooding around. So I get it.

Lorissa MacAllister, PhD (Enviah): Yes, for sure. But I would say like an example, so a project that we were doing, they had really  horrible patient experience scores for noise and sound. And so one of the aspects that you don't think about is sound. A lot of folks are measuring the noise level or the decibel level, but actually the higher the biggest  impact of sound on patient experience is actually the peaks of those. So it's the slamming of the doors, it's the rolling of the carts, it's  it's overhearing conversation. So the intelligibility of the sound is the thing that more impacts a perception of  sound or disruption or even safety we've seen.  so a patient might not feel safe if their information is being able to be overheard.

And so thinking about where people are stopping, we actually found that. because the space was most connected and most open in front of these exam room doors, patients were overhearing staff talking in front of them outside of their door. And so it's thinking about okay, where do we need to put those touchdown spaces to allow for that patient and that staff to have the proper conversation, not outside of a door but or with an earshot shot of that. So really thinking around where things are happening and placement of those. So allowing for an open space is good for certain aspects for care delivery, but then also the consolidation and kind of configuration of how that operations within the space is also important.

Stewart Gandolf (Healthcare Success): So I'll just share a personal example of how these things all fit together. So as a member of the Orange County, California sort of community,  one of the big players here is Hoag. And so for the outpatient services, it's so together. Like, first of all, when you go to some of the major facilities, all the stuff like urgent care is right next to primary care, which is right next to this, and you can get your blood drawn over here. So it's just easy for a patient. And then It's a very welcoming, well-lit environment when you first walk in. It's immediately sort of a peaceful thing as much as it can be with somebody coughing next to you, but still, but even then you have space to spread out if somebody is coughing. Like it's just so well thought through.

And you know, I'd love to do a talk some other day,  probably with somebody on the interior design part of it, right? The choice of plants, the choice of sound of fountains or this or that. These are all you know, the idea of how you're playing the space with who's next to who. You know, what does the physical space look like? Then the interior design is like the next level down. It is an enormous impact on the patient experience. And that just happens to be an example that it's it's all built into a system.

So one other thing I want to talk about beyond that comment, because I just think it's fascinating again, I'm just fascinated by human behavior and psychology. It's always really intriguing to me how people process. But that was actually notable as a professional and as a patient. I've noticed how well that they do it where I go.

You know, one of the things that I was going to ask you about, and then I think about this is in maybe a bigger picture. You know, the care isn't delivered like it was in the 50s either, right? So even if the forget the fact that it was designed before anybody thought of this, even if they had, the care is very different. So care is delivered today, you know, in telehealth or aging populations or integrative care settings, or, you know, needs change, right? It's doctor-centric. Now we have a lot of PAs or MPs or technology changes.

Like how do you build this flexibility into your system so you can adapt to changing needs and you know, thinking about models as they evolve?

Lorissa MacAllister, PhD (Enviah): Mm-hmm. Yeah, I think that it's important to have a full understand again. This is where the tool of understanding operations of how the patient is moving through the system. So back to what you were saying, they have to  a a great example would be in an oncology unit where they're maybe going to infusion. So a patient would come in and then they have to get labs drawn. And where are they getting the labs drawn? So the distance from from that lab.

And so as care evolves and changes, you know, the lab might be be somewhere located differently, but then the pharmacy that's compounding or preparing that infusion might be a radio pharmaceutical pharmacy, it might be some other pharmacy. And so being able to, whether it's you know, delivered by drone or delivered by you know, robot that those types of things are happening today real time. And so sometimes those distances don't matter because you're able to get them quicker, and the scale is  more effective.

And so I think that, you know, thinking about the flexibility and adaptability, it's not that everything needs to be open or everything needs to be enclosed or you know, everything needs to be right next to each other. There are means to allow again with technology interfaces now that you don't necessarily need to have everything immediately close to to the facility. And what could you do  ahead of the visit? So we see a lot of change in regards to pre-os and all of the prep to get onto site. So what can you do? and and really use the space within the hospital system as precious, valuable real estate for the organization to maximize that return and that time that whether it's the staff that's there doing their work or the patient experience in that location.

So again thinking of the opportunity to really say, okay, what is this real estate that I should be using and best using that for? Another trend we're seeing on the provider side is the tele-appointment. So you will see a an in-person, you know, visit and then maybe go to a televisit to another in-person visit. So the ease of moving from a in-person visit to a televisit, so you could the provider could have a higher productivity and  that ability to kind of navigate through that. is very important as well. So the fluidity of kind of where care is happening is changing for both virtually and in person.

And so the physical spaces, while they're important, I think it it really just  we we just need to continue to allow for the evolution to occur and use as much insights of what's happening within this space and what's happening operationally what what kind of clinical care you need to deliver and then what tools are available. So the integration of AI, Antella, all of that  needs to really be thought through and allowed within the within the facility  as they as you continue.

Stewart Gandolf (Healthcare Success): That's intriguing. The amazing world we're in right now, the idea of drones delivering radio pharmaceuticals or the use of AI, it's not to be able to think ahead and to pull the technologies that are already here and how can I use the stuff that's already here in a very novel way is intriguing. And I can see when you're thinking about space, which is so static and there and expensive, like it's really important to think bigger picture. So as we finish, I guess the last…

I don't know if have any question there. It's just a statement. It's like to me again, this stuff is fascinating.  if there's one thing that you wish every healthcare executive, you know, took away from this discussion that listens that's in a position to make decisions or that, you know, needs to understand about build environments, what would that be?

Lorissa MacAllister, PhD (Enviah): I'm gonna share an image and I'll talk it through, but I think the biggest can you see this image? Yeah, so essentially today healthcare leaders and organizations are looking at capacity of a human staff member in one way, but they there's no contextualization in regards to that ability for them to perform that work or a patient to perform their work. There's an effort that happens.

And that effort leads to burnout, that effort leads to poor outcomes, that effort leads to pa poor patient experience, whether it's a staff member or whether it's a patient visiting that facility, that effort of the context of in the space is what happens to the outcome. And so I think that what I would hope that most executives would be able to  take away from this conversation and recognize that Isolation of understanding of patient experience without an understanding of context in the physical space, you'll never achieve the outcomes that you're looking to achieve.

Stewart Gandolf (Healthcare Success): That's terrific. And  how should people reach out to you?

Lorissa MacAllister, PhD (Enviah): You can reach out to me at enviah.com, enviah dot com.

Stewart Gandolf (Healthcare Success): Very good. Lorissa, thank you for your time today.

Lorissa MacAllister, PhD (Enviah): Yes, thank you so much, Stewart.