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, in part 2 of that interview, Murphy expands on MASS's most recent projects and initiatives.

Healthcare Design: You have two projects currently under construction in Haiti, to address dire conditions created by the 2010 earthquake. How did your Rwanda experience inform these projects?
Michael Murphy: One project is a multi-drug-resistant tuberculosis (MDR-TB) facility; there, we’ve carried over many of the infection control strategies that we learned about in Rwanda, such as maximizing cross-ventilation and being specific about keeping infectious patients isolated. In this facility, we know that every patient will have MDR-TB. So the challenge is the inverse [of Butaro]: All the patients are infectious, so how do you keep doctors, nurses, and cleaning staff from getting infected? The strategy is to isolate the patients, and then bring them out to the exterior when they meet with staff, families, and others.

We also have two doors to each [isolation room] bathroom. The patient can go to his or her bathroom, and then the cleaning person can go through the door from the exterior. [Cleaning staff] doesn’t have to go through the bedroom to get to the bathroom, so they don’t have to go through the infectious room. Simple things like that are big infection-control principles.

The second facility is a cholera treatment center. Cholera is a different problem of infection control—it’s a waterborne disease. Port-au-Prince doesn’t have the sanitation system to cope with an outbreak of that kind of disease. The sewer treatment system is designed for something like 500,000 people, where the city now has around 2.5 million. The cholera outbreak started in the mountains, but when it moved into the urban environment, it created one of the worst outbreaks ever recorded. With the lack of appropriate infrastructure, negative health outcomes can be much more dramatic.

So we had to think not only about a cholera center that could rapidly treat a potentially epidemic-sized proportion of patients, but also about the long-term outcomes of treating that waste. This is the first permanent facility there. There are a lot of cholera treatment tents that were put up by Médecins Sans Frontières, and other emergency-relief tents, but cholera’s going to be in Haiti for another 10 years minimum, according to [Haitian physician and global health leader] Dr. Bill Pape, and he thought we need not only a center that will treat cholera and other diarrheal diseases, but also to train people on how to treat this disease.

We asked similar questions as we did in Rwanda: If the health outcome goal is to solve cholera, why don’t we treat the cholera on-site? That allowed us to design and develop a mini-wastewater treatment plant on-site. The building itself acts as a water treatment plant. Its roof design is based on the collection of rainwater, so we’re harvesting a huge amount of rainwater into a giant 18,000-gallon tank underneath the building. That water is used to clean the facility—because a cholera facility has to be cleaned upwards of four times a day. It takes a lot of water to clean it, to wash patients, and to keep this facility decontaminated. The secondary system [on site] collects all the contaminated waste and decontaminates it.

There’s an opportunity to prototype the process. We can replicate many of these permanent cholera treatment centers that have independent wastewater treatment facilities. If you could do 10 to 20 throughout the city, you could in many ways leapfrog the need for a massive sanitation system. You’d still need a centralized wastewater treatment facility, but you could help reduce the need and demand on its limited resources.

What other healthcare projects are you working on now?
Now that we’re larger, we’re working on a number of facilities in Uganda, and in Liberia we worked on a pediatric hospital. We have some work in the U.S. as well, with a renovation of an old 1960s hospital in upstate New York. Cama Inc. [New Haven, Conn.] did the interiors, and we did the design of the building, and together we did a research project.

Where do you want MASS to go from here?
In a really broad, big-picture way, we want to see the expectations change, so that society expects buildings to have a positive impact on their lives. If the last decade was about environmental sustainability, there’s really an effort now toward the social indicators of our built environment. That’s the next era of work that needs to be done. If that’s successful, society will expect from architects and our buildings much more than we do now. We’re focused on driving and being a part of that movement, and working on projects that are examples of that.

The director of the cholera center told us that the people working there talk about the design of the facility like it’s their own. They talk about infection control; it’s the first thing they mention when they talk about the design. And it’s a beautiful thing to hear, and the doctors say, “We love this facility because we know that infectious patients will be healthier here.”

There’s a real shift from when we started this project. Then, a lot of what we’d hear was, “We just need the bare minimum; just a simple building where we can do work.” Now there’s an understanding of the direct relationships between health outcomes and the environment.

Part 1 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 Healthc
are and Nemschoff’s creation of specialty furniture for cholera patients at MASS’s new center in Haiti, see “Bringing Health and Hope to Haiti.”