At a time when “improving patient outcomes” is the first thing off anyone’s lips regarding the ultimate goal in designing healthcare facilities, the work of MASS Design Group (Boston) stands out as an extreme example of that goal in practice.

Michael Murphy, MASS’s co-founder and executive director, was inspired to create the nonprofit group after Dr. Paul Farmer, co-founder of Partners in Health, came to speak at the Harvard Graduate School of Design in 2006, when Murphy and MASS co-founder Alan Ricks were students there. After striking up an e-mail correspondence and then spending a summer in Rwanda working with Partners in Health, Murphy was invited by Farmer to design a hospital in rural Rwanda. MASS was formed in 2007 to serve that need.

”Design is never neutral; it either helps or it hurts” is the firm’s guiding philosophy. The team has taken on projects in other devastated areas of the world, creating effective and elegant facilities that go far beyond improving patient outcomes. They’re improving the lives of entire communities through skills training, job creation, and facilities that address the whole spectrum of healthcare needs.

The Center for Health Design named MASS Design Group the winner of its 2013 Changemaker Award, which Michael Murphy will accept at the Healthcare Design Conference in Orlando (Nov. 16-19). Healthcare Design sat down with Murphy to discuss his organization’s growing mission, its projects, and lessons for the future. Here, he details the firm's very first project.


Healthcare Design:The first project on MASS Design Group’s boards was the Butaro Hospital in Rwanda, which opened two years ago. Where do things stand with that facility today?
Michael Murphy:It’s been a great success; it’s attracted new investment ever since its opening. New partners have come to the table to make it even better than we had envisioned it, and that’s what we find most exciting. We anticipate six phases of Butaro to become a fully fleshed-out hospital, a full teaching facility, and a center of health for east Africa. Phase 2 opened in December, which is housing for staff and doctors.

Phase 3 is the first cancer center in Rwanda, which will open in the fall. There’s this interesting problem in global health, which is that so much of funding to date has been about communicable diseases and vertical programs, and HIV treatment. But Rwanda has the same cancer rate as any other country, yet they have virtually no cancer care and it’s incredibly expensive. Other noncommunicable diseases, like diabetes, are as big a problem as anywhere else, but there’s very little treatment for that. So this is part of the commitment of Partners in Health and the Ministry of Health, to start investing to affect the long-term health of the entire population.

For us, the story of Butaro has been a really compelling one about how people could come together and develop a vision for a new type of rural hospital. But now, what I think the story’s becoming is that it’s not just about design for infection control—it’s about how a project of this scale can be an engine for economic development in an entire region. I think what we’ll see in 10 years is this facility having a massive effect on this whole region and be a real success story in a broader, new model for economic development, using healthcare as the center for that.

Let’s talk a bit about those initial goalsspecifically, infection control. What are some of the design innovations you were able to implement?
Our basic premise was, how can design decisions affect health outcomes? So infection control became primary; the first challenge was being in a setting with a limited electrical grid. In the U.S., what we usually do is get a large mechanical system to take care of all that infection control through air handling. But in Rwanda, we had to do it through natural ventilation. The design of the building gives us a naturally ventilated facility that gets enough air changes per hour so that serious infection (or at least airborne infection) will be reduced. But it’s not enough to just have natural ventilation; you have to have redundant systems. So we introduced simple low-tech technology, like large industrial fans, to get air into the upper clerestory area of the wards. When the air is up there, we can actually disinfect it with another low-tech technology: UVGI (ultraviolet germocidal irradiation) lights.

Of course, there are other strategies, as well, such as keeping [infectious patients] outside, in collective areas. The patients we know have potential infectious diseases are kept in waiting areas and on pathways that are outside. The campus is designed around certain trees for outdoor areas that are shaded; we use signage to guide people to multiple waiting areas so they’re not clustered in one place.

What design strategies did you use that went beyond infection control?
We were thinking from the perspective of the patient, in that they’re coming to a facility after a number of hours walking, and they’re very sick. Why would you, when you come into the ward, want to look at a bunch of other very sick patients? If you think about a typical ward, it has beds around the perimeter, with a hallway down the center. It’s very doctor-centric in many ways. Doctors can walk in, look at all the beds, and walk out.

By inverting that, by putting beds [feet-out] against a low center wall, each bed can have its own window so patients have a view outside. These principles—evidence-based design and human-centered design—allow us this very simple intervention that’s had great success. I think the doctors really like it now, and patients appreciate it.

Part 2 of this interview can be found here.

For more examples of MASS Design Group’s efforts to connect the dots between architecture and building stronger communities, see “Architecture’s Role in Reducing Social Vulnerability.”

For an account of Herman Miller Healthcare and Nemschoff’s creation of specialty furniture for cholera patients at MASS’s new center in Haiti, see “Bringing Health and Hope to Haiti.”