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.

Thomas Knittel is a design principal at HDR’s Seattle’s office. Here, he shares his thoughts on regenerative design, incorporating architectural elements to reduce staff burnout, and how biomimicry can drive new building designs.

1. Regenerative design

Regenerative capacity, whether tissue repairing itself or an ecosystem recovering from disturbance, is a wondrous thing. The design fields are embracing this concept as a framework to assess how our actions move from a “take, use, and dispose” model to a “circular, nutrient-flow” model. Why is this important? We are simply racing through planetary resources and releasing too much fugitive carbon to continue the old way. The best answer we have is to move toward appropriately-scaled net zero energy, water, and waste models. There are a few net-zero energy hospitals: Gundersen System, which uses a range of renewable energy sources, including biogas; Weed Army Community Hospital, which is purely solar; and the Clinton Children’s Center in Haiti, nearing completion, which is targeting triple net-zero and LEED Platinum. Historically, it’s been hard to convince healthcare institutions to invest in sustainability measures, such as reducing energy consumption, because it accounts for only 5 percent of their operating budget. However, fossil fuel-based energy is one of our biggest externalities, including its impact on soil, water, and air, which in turn, can impact human health. If one industry should care the most—and be at the heart of the regenerative movement—it should be healthcare.

2. Building wellness

Three million people are moving to cities every week, and within the next 15 to 30 years, two-thirds of the world’s population will live in urban environments. Cities hold specific challenges; they may offer more walkability, but many have terrible air quality. Even in Seattle, where I live, adverse air quality from vehicles and polluted run-off into our waterways are much greater than most people know. Our cities—and our buildings–will continue to shape our health trajectories. Enabling better health outcomes in cities, and in buildings, will not only create more vibrant and healthy places, it will be a great design opportunity.

3. Connecting with nature

To create these new livable cities and healthcare facilities, we should look to nature. In 1982, Japan began the inclusion of shinrin-yoku (forest bathing) into its national health program—a practice defined as making contact with and taking in the atmosphere of the forest, which has been shown to decrease pulse rate and blood pressure and boost human immune system activity. The integration of natural elements and their attributes suggests the possibility of a continuum of care that stretches from nature to the built world. We’re exploring new ways to connect patients, caregivers, and researchers to nature through building design. At the Shirley Ryan AbilityLab in Chicago, there are perched gardens that infuse the building with periodic doses of nature. The multiple benefits of infusing nature in our cities, and blurring the distinction between inside and outside, is high on our list.

4. Using design to reduce burnout

Medscape’s “Lifestyle Report 2017” found that nearly 60 percent of emergency department (ED) physicians were feeling the impact of burnout. And while the ED is just one area of a healthcare facility, all departments and spaces should be examined to properly address this pervading issue. As we continue to understand the importance of healthy buildings on health outcomes and their impact on provider burnout, it becomes imperative that we design facilities that aid in the improvement of physical and mental performance in demanding settings. Introducing elements of nature or supporting circadian rhythms through lighting, alongside essential air quality and daylight access, are just a few ways to provide relief and improve clinicians’ health and wellness.

5. Searching for new ideas

Collaborating with biologists, scientists, and anthropologists creates an opportunity to find new answers and expand design thinking. For example, biomimicry is an emerging field that looks to nature as a source for sustainable solutions to human challenges by emulating nature’s patterns and strategies. For example, at the William Jefferson Clinton Children’s Center in Haiti, the design journey started by looking at deforestation and the emissive qualities of bark (you could call it a smart material), which led to the design of a diaphanous wood skin that admits air and rejects heat. An initiative of the US Green Building Council, the facility is designed to be a LEED Platinum, triple net-zero building, with a design that’s not only infused with nature, but informed by it. If this is possible in Haiti, why not everywhere?

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