The second day of HCD Virtual kicked off with The Center for Health Design presentation of is 2020 Changemaker Award to Cyndi McCullough, senior clinical planner at HDR (Omaha, Nebr.). The annual award honors individuals or organizations that have demonstrated the exceptional ability to change the way healthcare facilities are designed and built, and whose work has had broad impact on the advancement of healthcare design.

During a video presentation and then Q+A discussion with Rosalyn Cama, president of Cama and chair emeritus of The Center’s board of directors, McCullough talked about her career journey that started in nursing before eventually leading to her current position as senior clinical planner at HDR (Omaha, Nebr.), work on patient-focused care, and commitment to bringing the value of evidence-based design (EBD) to the forefront.

McCullough’s career has included 3 million miles and spanned multiple disciplines, including as a nurse manager of a transplant and urology/nephrology unit and a senior clinical planner, as well as projects such as a new critical access hospital 340 miles north of the Arctic Circle for the native Inupiat and a new hospital, King Faisal Medical City in Saudi Arabia, that is currently under construction. McCullough has written and spoken about EBD at universities, conferences, podcasts, and webinars. In addition, she holds EBD and Lean healthcare certifications.

However, despite her 30-year career in the industry, McCullough shared that healthcare design wasn’t her first choice. “When my sister suggested I consider nursing as a career, I thought she was crazy,” McCullough said. Nevertheless, she took her sister’s advice and decided to leave her education studies to pursue nursing. After graduating from nursing school, she landed a job at Bishop Clarkson Memorial Hospital, now part of University of Nebraska Medical Center. “It turned out my sister was right, I loved my job, as did my coworkers,” McCullough said. However, she quickly discovered that healthcare in general was fragmented, patient rooms were way too small for families and equipment, and supplies were never where they needed to be. “The physical environment did not support our workflow,” she said.

This prompted McCullough to participate in some early research on patient-focused care at the hospital, which eventually led to incrementally renovating the facility floor by floor, examining and improving processes, and changing behavior. “A major focus was improving the experience for the patient—from the time the patient walked through the door until they received treatment,” she said. “[The hospital] formed a consortium to tackle the idea of changing the way healthcare was delivered and how patients were treated. It was expected that a new model of care would lead to cost reduction, efficient use of workers, and improve patient outcomes.”

Her personal experiences nursing and her research fueled a passion to seek opportunities to create efficient healing environments on a broader scale. “I soon realized that most of my workday was spent consulting with staff from facilities around the world. And that was the part of my job that I enjoyed the most,” she said. “I knew that working with an architect was the best way to push change and facility design.”

She joined HDR and began a new career in healthcare planning. “[Healthcare planning] wasn’t just new to me, but also a new to a profession that was only just beginning to understand the facility implications of design interventions, operational planning, and technology to deliver a better, more efficient quality of care,” she said. “Our goal has always been to apply evidence-based design strategies to change how healthcare facilities are programmed, planned, and designed to improve staff efficiency and satisfaction, and above all—patient experiences and outcomes.”

Intermountain Healthcare was an early supporter of the EBD movement and served as one of The Center for Health Design’s first pebble projects. One of McCullough’s favorite projects is an Intermountain project—Utah Valley Regional Medical Center in Provo, Utah, a multiphased replacement facility focused on both improving the patient experience and operational efficiency for caregivers using design strategies with a large body of evidence to support positive outcomes.

Most recently, McCullough said she’s been thinking about healthcare during the pandemic and whether health systems or associated hospitals should have a separate pandemic hospital or if all facilities should be resilient to handle any level of disaster. “Maybe it’s more important to make sure we have the right amount of staff and that staff are trained and designated to those facilities,” she said. “I think we’ve also learned a lot about space needs—especially respite spaces for staff.”

While she thinks there’s still work to be done when it comes to the EBD process framework, she said she feels fortunate to have helped pioneer what she called a “rebel revolution” that laid the foundation for widespread recognition of the benefits of EBD and the subsequent adoption of its principles. “I’m inspired daily by our work and the work of our competitors,  using each project to learn, grow, and achieve demonstrable improvements that can be used to improve the next project,” she said. “It never gets old.”

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Tracey Walker is managing editor of Healthcare Design. She can be reached at