In this series, Healthcare Design asks leading healthcare design professionals, firms, and owners to tell us what’s got their attention and share some ideas on the subject.

Ashley Dias is the director of healthcare strategies at Perkins and Will (Dallas). Here, she shares her thoughts on the shifting care tiers, flexible planning, and why firms need to be multidisciplinary to address the paradigm shift to a culture of health.

  1. Evolving (and nuancing) the care pyramid

Traditionally, the levels of the care pyramid have consisted of four general tiers: primary, secondary (specialty), tertiary, and quaternary care. Because of an increasing focus on patient engagement, care relationships, and population health, these levels of care are becoming more nuanced. For example, primary care is being slivered away from traditional into virtual and retail care.

In addition, secondary care offers access to more advanced diagnostic and treatment components than before. We also see more tertiary care moving to outpatient and observation settings (both in and out of the hospital environments), with quaternary care becoming more complex as a result. There’s no prototype of care model, network arrangement, or care environment for these shifting ties at this point because the nuances call for creativity and customization for the clients and populations served. What worked for your last client, is just that. Ask your clients strong questions on their care models and get to know their nuances, so you can create solutions that are responsive to the organization of care they deliver.

  1. Synergizing specialties for cross-market convergence

Last year, the Dallas studio of Perkins and Will hosted a Think Tank on “Building a Culture of Health in North Texas,” energized by cross-sector collaboration from experts in business, government, K-12, higher education, real estate, high technology, transportation, and the arts. One pertinent theme that emerged from our discussion was that an increasing amount of opportunities are arising that require cross-market and cross-disciplinary thinking. Take, for instance, the rise in interest to develop high schools focused on teaching healthcare career opportunities; urgent care clinics in airports; or innovation districts that closely locate medical research, technology development, and healthcare. Understanding the future of healthcare’s spatial needs requires both a broad and specific understanding of markets and disciplines.

  1. Planning for pivots

A few years ago, I was developing a master plan/capital road map for a client in an urban setting, including inpatient and outpatient scope.  We built a strong plan to address the client’s market conditions and aspirations, articulating ideas with detail and precision. Then a change occurred in the client’s market that couldn’t have been foreseen, and a portion of the plan that had initially been targeted for a later stage quickly got pushed up and prioritized. The takeaway: You must consider the pivots you don’t see—preparing with more than just flexible planning, but by also considering changes that impact priority, scale, geography, price, and purpose. To serve our clients optimally, we must consider the what-ifs so clients aren’t stranded when things substantially change.

  1. P4 Health

Healthcare is becoming more predictive, personalized, preventive, and participatory—the so-called “P4.” With the advent of data tracking, more real-time intel is shareable between patient and doctor. As a result, access to a provider from an outpatient perspective is becoming more seamless. Care is becoming more focused on wellness over sickness. Patients are engaging with their providers in a way that gives them choice, empowerment, and control using technologies such as app-based scheduling, digital biometric monitoring and reporting, on-demand video consults with providers, and text reminders.

But the impact of P4 may be even broader than expectations of technology integration to care models—P4 may drive patient expectations of our environments too. For instance, as artificial intelligence (AI) capabilities grow and aid in the diagnostic and treatment realm, physicians will be afforded more time to focus on their relationships with patients and deliver more personalized care. With that, the caliber of care relationships will rise, as will patient expectations of those care interactions. Consequently, our physical care environments will also have to rise in quality with more focus on features such as comfort, connectivity, augmented reality flow, resiliency, material quality, convergence of markets for convenience, and so forth. Everything will have to fire on all cylinders.

  1. Building a culture of health

Social determinants of health, a term coined by the Robert Wood Johnson Foundation (RWJF) to encourage the philosophy that health is broader than just healthcare, has become nearly mainstream in the last year or so.  This paradigm shift to a culture of health will require cross-sector collaboration.  Consequently, design firms who already have cross-sector and multidiscipline abilities are primed for the future by being able to address the complex programs and creative solutions required for clients and our communities’ health.

Ashley Dias is director of healthcare strategies at Perkins and Will (Dallas). She can be reached at

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