When Roderic Walton was pursuing a graduate degree in architecture at Miami University in Oxford, Ohio, in 2003, he wrote a thesis about the implications of a Eurocentric curriculum on architectural design. Specifically, he recalls, he explored how African and African American contributions to U.S. architecture weren’t considered.

A Black man, Walton found himself missing from the narrative.

“I had a hard time finding a path for myself as a young architectural student who was trying to figure out if this was a career that I wanted to dedicate my life to because I didn’t have a whole lot of role models who looked like me, and the history being taught was that I had nothing to do with making architecture great,” he says.

However, the program has evolved significantly since then, he adds. Walton, now a principal and project manager at Moody Nolan (Chicago), remains in contact with his alma mater, which has committed to developing a more inclusive curriculum that incorporates conversations about people of color and their influences on the field. “Understanding that history and having that historical perspective establishes a foundation for the entire industry to now be more inclusive and embrace people of color at a broader scale,” he says.

Walton joined four other healthcare design professionals recently to speak with Healthcare Design and collectively explore the topic of diversity and equity in the industry.

The group also included Taft Cleveland, architectural designer at SmithGroup (Chicago); Ariana Hallenbeck, designer, associate, and diversity champion at Perkins&Will (Dallas); Victoria Navarro, regional director of planning, design, and construction at Advocate Aurora Health (Milwaukee); and Tammy Thompson, president of the Institute for Patient-Centered Design Inc. and corporate director of experience design for Vidant Health (Greenville, N.C.).

Representation in healthcare design

The panel shared similar experiences as Walton’s in terms of finding few role models or peer representation in the design field during their early careers, especially—Navarro was one of three women who graduated from her college architecture program, and Thompson was among the 0.2 percent of female African American registered architects when she entered the profession.

Cleveland shared that during his 15 years in the industry, he’s been either the only Black designer or one of two in the three firms where he’s worked, while Hallenbeck, an industry newcomer in the fifth year of her career, is one of two Black registered architects in her Dallas studio.

However, improvements have been made over the years—particularly recently as the discourse over mounting issues of systemic racism and health inequities have inspired both individuals and businesses to drive diversity, equity, and inclusion (DEI) initiatives.

In the healthcare design industry, specifically, efforts are focused on encouraging more women and people of color to not just pursue architecture as a career but focus on healthcare, promoting diversity within project teams and organizational leadership, and informing design solutions that will help correct health disparities within communities.

“We can develop so many wonderful solutions when we have equitable representation at the table to contribute to ideas, and I think we all want more of that,” Thompson says.

Start with community outreach

Achieving that vision of diversity requires first attracting individuals to the profession. To that end, healthcare design firms are exploring programs to reach young people, expose them to architecture, and help guide their career paths.

For example, Cleveland is helping to drive a five-year partnership between SmithGroup and three Historically Black Colleges and Universities (HBCUs): Florida A&M University, Hampton University, and Howard University. The program focuses on mentorship, internship, and sponsorship of design studios.

The strategy, he says, is driven by statistics—of the 132 colleges in the U.S. with National Architectural Accrediting Board-accredited programs, the country’s seven HBCUs produce over one-third of the Black graduating architects. “We have to start targeting those demographics and increasing the number of graduates and financial resources to those architecture programs,” he says, with the ultimate goal to not only boost diversity in the talent pool but provide students with valuable mentorship and access to the field.

Similarly, Walton says Moody Nolan is working with middle and high schools to expose students, specifically those of color, to architecture at an even younger age. The program helps students understand the craft by bringing them into the firm’s office to participate in a mock project, learn how to use design thinking to solve problems, and conceptualize the roles of project players ranging from clients to contractors. “At a very young age, you’re sparking that interest. By the time they get to where Taft’s program starts, they’ve already identified this as a solid career path,” he says.

Hallenbeck says she personally was inspired by an architecture program she participated in during high school. “That’s really why I’m here. I think if I wouldn’t have had that program, I wouldn’t be an architect today,” she says, urging industry members to pursue very deliberate approaches and not wait for students to come to them. For example, her Dallas office of Perkins&Will identified a local middle school and offered to deliver design coursework there.

And while such efforts lay a foundation for exposure to architecture and design in general, the next critical step is making the connection to healthcare. “We have to work so much harder to get people to think about healthcare architecture,” says Navarro, who’s one of the founders of She Builds, an organization that works to raise awareness of and exposure to women working in the design and construction trades. She also participates in ACE Mentor, a program that provides young people with mentorship and on-the-job training in the architecture, engineering, and construction industry.

The solution, Hallenbeck says, is following Navarro’s lead by ensuring healthcare professionals are represented in such efforts. “If we want to expose students to healthcare design, healthcare designers have to be the ones doing this sort of outreach,” she says.

Developing a DEI strategy

While programs like those outlined will help achieve goals for diversity within the healthcare design industry, the group also discussed what their vision is for the future—starting with defining success.

“Diversity is just counting heads, counting the number of different types of people who you have at your organization. Equity is acknowledgment of historical disparities and that not everybody starts their journey as an architect or healthcare architect in the same place,” Walton says, adding that inclusion is then the ability for employees to be their “true and authentic self” without feeling it limits them within the workplace. “It’s defining what those terms are and having a measuring device to see and assess how firms are doing and giving resources to improve if they need them,” he says.

Hallenbeck agrees, saying that DEI programs provide companies infrastructure to help drive change, but change requires accountability. “Without true tracking, you’re going about it blindly. You have to be realistic about where you’re at and establish your goals to then move forward and accomplish them.”

Further, goals should ensure that diversity, equity, and inclusion aren’t “market-driven words but words with action,” Cleveland says. Action can include solutions ranging from pausing to see who’s at both the design and leadership tables to making sure people in project renderings are representative of communities being served. “It’s about changing the entire culture of firms and how we interact with our clients and how we interact with healthcare in general,” he says.

One way to inspire a shift in culture is to encourage conversation on subjects that may feel taboo within the workplace, such as social disparities and police violence. Walton says Moody Nolan launched a “Walk the Talk” program to achieve just that. “It’s creating a safe space where we can talk to white colleagues about our experiences, how they shape our world view, and why it matters that a large percentage of the architectural community doesn’t know what it’s like to be a person of color or doesn’t know what it’s like to be the only person of color in a room,” he says. “We absolutely need to talk about issues of race and disparity, particularly in the healthcare sector, because the implications of that are so profound.”

And that’s why the healthcare industry has made strides to promote diversity within its organizations faster than what’s been seen within design firms, Thompson says. She cited examples of inequities found in healthcare research such as higher rates of maternal mortality in Black women and inequitable health access for nonbinary individuals. “If you’re not comfortable as a design consultant having those types of open discussions, then you’re going to find yourself at a disadvantage because we’re having those open discussions in healthcare,” she says.

DEI as a business necessity

Pursuing meaningful DEI initiatives may become a business necessity, as well. Navarro says it’s already a qualifying factor for project team selection at Advocate Aurora Health. “When we are differentiating between firms and hiring for projects, absolutely that is a competitive edge: to align yourself with a healthcare system’s mission and goals, to empower diverse perspectives, and have people in front of me interviewing who are mirroring my team and the communities we serve,” she says.

And Navarro is looking for more than one-off examples. “I’ll ask, ‘What is your DEI strategy?’” she says. “It’s got to be engrained in your culture at this point. Otherwise, you’re not aligned with our mission.”

Additionally, Advocate Aurora Health is leveraging its buying power to spend money with women- and minority-owned local businesses as well as choosing manufacturers and suppliers—for everything from medical equipment to design and construction materials—who are similarly working to address disparities (including analyzing additional layers of their supply chain). “That sends a message,” she says, adding that the organization is tracking progress and resetting goals once met.

Benefits of diversity on healthcare design

More than simply earning business, diversity within project teams stands to result in better work, too, the group discussed. For Cleveland, diversity in healthcare design means the ability to achieve empathy by having a team in place that can understand complex communities and design facilities that address their needs.

More so, project outcomes can be improved when community members help inform the design, Hallenbeck adds—an effort that can be derailed due to inherent distrust between people of color and healthcare organizations and their partners. “When we’re able to have diverse teams to send into the communities, they’re able to connect and relate. There’s a different level of comfort that exists when you on the community side are not the only person of color in the room, and I think that helps us get the trust and buy-in that we need,” she says.

Thompson adds that there’s room for improvement on that front, as well. For example, patient and family advisory councils (PFACs) generally rely on volunteer participation, meaning those who might not be financially able to devote the time to participate could be inadvertently excluded. When this occurs, PFACs run the risk of missing important perspectives, she says. “What that means is most hospital programs across the country with patient and family advisors have some work to do in terms of diversity so they can have the full picture of the patient population they serve,” she says.

Overall, though, healthcare is an evidence-based field, and data has indicated the benefit of diversity, Thompson says. “When you see research studies, for example, that suggest better health outcomes with a more diverse nursing staff … when the team mirrors the diversity of the patient population, that speaks volumes,” she says. While not as clearly demonstrated in healthcare design, Thompson adds that there is data that points to a connection between diversity in terms of collaboration and innovation. “I think it would be wonderful to start looking at that in healthcare design, whether projects can be more innovative when you have diverse contributors at the table,” she says.

Addressing DEI together

As more diversity is brought to the design table and goals are set and achieved, Thompson warns organizations to be mindful of what’s expected of those new hires in terms of leading or even contributing to DEI programs. “Don’t expect individuals to represent everyone they identify with,” she says. “That’s a common mistake.” Rather, Thompson says leaders must educate themselves and their teams.

And anyone can contribute, Hallenbeck adds, encouraging all industry members to become active allies in such pursuits. “Yes, I am comfortable having these conversations, but even as I work to educate the industry, a lot of research happens on the back end so that I feel comfortable talking about all of these issues. Anyone can easily take that on,” she says. “This is not an issue that just affects people of color; this is a global issue and one we should all work on addressing together.”

Jennifer Kovacs Silvis is editor-in-chief of Healthcare Design. She can be reached at jennifer.silvis@emeraldx.com.