Louis A. Meilink, Jr.: “How Do We As The Design Community Contribute To Population Health?”

Louis A. Meilink, Jr.: “How Do We As The Design Community Contribute To Population Health?”


(light music) – Okay, howdy.
– [Audience] Howdy. – Well that’s good. Welcome to our Architecture
for Health lecture series. We have the next to the
last in the series today and we have Lou Meilink
who is with Ballinger, and he flew all the way down. We got him good weather from Philadelphia. And Dr. Zhipeng Lu is gonna introduce Lou and we have our final
lecture on Tuesday at 12:40. And then Aggie Land, the
last day of the semester somehow, we go to Friday classes. I always get a kick out of that. So I think you can handle
that ’cause I can handle it. Zhipeng. – Thank you Charles. And now it’s Lu introducing Lou. I’m delighted to introduce
our speaker, Mr. Lou Meilink, AIACHA and ACHE. And Mr. Meilink is a
principal from Ballinger in Philadelphia. He has developed a
national practice focused on programming, planning and design of healthcare facilities. In the past 31 years in
Ballinger, he has designed solutions that shape the
future of healthcare facilities such as academic health
center and community and regional hospitals and
healthcare delivery systems. So he works closely with the clients to develop facility
solutions and translate really complex project concepts into really simple approaches. Lou’s the orientation to work kind service and high quality, cost
effective approaches has brought him recognition from not only the healthcare institutions
but also his peers. So please join me to
welcome Mr. Lou Meilink from Ballinger, thank you. (applause) – Well howdy.
– [Audience] Howdy. – So it’s an honor to
be with you here today and have the opportunity
to talk to you about how we as the design community contribute to population health. And Professor Lu, thank you
for that kind introduction and I would encourage
everyone to follow me on Twitter or LinkedIn, and let’s continue the conversation. So my firm Ballinger is an
integrated architectural, engineering and interior
firm in Philadelphia and founded in 1878,
we’re the oldest actively practicing firm in the United States, celebrating our 140th
anniversary this year. And we focus on complex
projects for health, education and science. We have the privilege
of working with many top academic centers and leading regional and community hospitals
around the country. And we really practice at the intersection of award-winning design,
but also our nationally recognized though
leadership and expertise. And it’s really at this
intersection that we continue this culture of innovation
that’s been our long history and that everything we do is about design and design matters. So today I’m gonna kinda set the stage with the big picture and talk a little bit about population health,
health determinants and the importance of place. And then I’m gonna tell you
five different project stories and how from design and as
architects we contribute to population health. So about 15 years ago, population health was a new term that really focused on the health outcomes
of groups of individuals and the idea of studying
health determinants to understand how and
why some people get sick and others do not, and how
do we improve the health globally in the world. And in 2008, the World Health Organization and their commission
on social determinants really said that they felt
that these determinants were responsible for most diseases around the world and in
fact about 70% in the US to preventable deaths. So if you look at this chart
here, you’ve probably seen various graphics like this
of health determinants and you can see that about
20% of our health outcomes from the actual clinical care you receive and about 10% for the
physical environment. So very important 30%, but
70% of our health outcome is really about social factors
and our health behaviors and our lifestyle choices. So this is a map of
Philadelphia by life expectancy based on zip code. And if you were to look
at kinda the center here and see the 86 average life expectancy on Rittenhouse Square in
Center City Philadelphia, and then you go just a
mile and a half north to Temple University area and the average life expectancy is 68 years. So an 18-year difference
in life expectancy within a mile and a half in Philadelphia. It’s pretty amazing. And you’ve probably heard
that if you know someone’s credit score and you know their zip code, you can estimate their life expectancy. So place and location really do matter. And last year I co-authored an article, The Evolving Quadruple
Aim that was published in MCD Magazine, that
really talked about the idea of taking Don Berwick’s triple aim and adding place as aim of itself. And you’ll see on the desk in front of you I’ve provided you a
reprint of that article that you can read at your leisure. And we would argue that
you can’t really achieve the triple aim of the right
care at the right cost and at the right time if you don’t do it in the right place. If you don’t have the
right place and you don’t have access, you will
not meet the triple aim. And one example of the importance of place is we look at every day
manage of daily illnesses if we look at telehealth, to urgent care to the emergency room and you can see that spectrum of localized the access and the cost and the
specialized, it’s a very significant difference. And most healthcare
institutions have already for years now been
looking at how to provide telehealth and urgent care. And others are looking at
this even more significantly moving forward. And this is especially true as look in the United States
that three out of every four dollars we spend in healthcare are on chronic disease. And they’re responsible
for 2/3 of our deaths. And so if we look to the future now and say that with new factors
like childhood obesity and the fact that folks
may live 50 plus years with multiple chronic diseases, how are we gonna manage that? How are we gonna pay for that? So this is a comparison
between the health determinants we just spoke about and how we spend on healthcare in the United States. And again you can see kinda the 20% of clinical care that
affects your health outcome, but you can see that we’re spending 88% of our healthcare dollars on sick care. We actually spend very
little on social programs and really working toward
wellness and prevention. Is that how we should
be spending our dollars. Is that the value proposition. And this graphic kinda shows
that anomaly in spending between health and
social, but if you compare the US to many of the
countries around the world where our total spending
may be in the median, how we’re spending our
dollars is very different. So you can see in the kinda
darker blue color there, we’re spending 18% of our GDP on sick care versus about plus or minus
10% for most other nations. And we’re spending a
little on social programs, and you can see many
other nations are spending much more money going upstream
on wellness and prevention. So it really asks the
question thinking of value, do we need a new social
contract with America. And then we’ve also been
talking about social return on investment or social ROI and the idea of measuring
values and contribution that go beyond the traditional values of things like financial
and really look forward. And we’re gonna talk about social ROI and kinda touch on that in a
number of our project stories. But ultimately we need to measure success. And how do we measure, how
do we agree on measurement and how do we know when we get there. And one example is it’s
really about quality of life. It’s not just how long you live. So now kind of at a big
picture having set the stage and about population health
and the importance it plays. I wanna talk about the
spectrum of really coming from the region to the city all the way to the patient room. And really think about what
are the kinds of places and locations where
healthcare is delivered and how do we as the
design community contribute to population health. So I’m gonna tell you five
different project stories, and these we will be very different sizes, different cost, and different locations. And in each of these we’ll kind of assess these kind of six key factors for design in population health, and
we’ll do a little scorecard, and I’ll hit some of the highlights. But you can see that
we’ve added the social ROI to those key factors. So our first story comes
from Puentes De Salud in downtown Philadelphia,
and it was a collaboration with Penn Medicine and the
design collaborative there and really taking and creating a clinic for underserved Latino population. And this space here that
you see was found space under a parking garage that was owned by Penn Medicine to create this clinic and really kind of go
upstream to provide services that the community was not receiving. And we did this work,
Architectural Engineering and Interiors pro bono. Penn Medicine collaborated. LF Driscoll was the
contractor, and many folks donated materials to try
to create this center for low cost. And you can see the range
of services provided here from the medical and dental,
and the women’s health and prenatal education was a
very significant component. You can see a range of
wellness and education programs that the center provides. And now I’d like to show you a short video that talks a little bit
more about the center. (light music) – These communities are in turmoil. Many of them come out
of Mexico very healthy, you know without a lot of chronic illness. They don’t wanna be sick, they wanna work. (light music) We started seeing patients
clinically in 2006 and just as the population grew and we gradually expanded
our patient practice, and now we have about almost 5000 patients in our electronic medical records system. (speaking foreign language) For the most part we’re
a volunteer organization. We didn’t go in looking
to screen blood pressures and just do research. We went in trying to figure
out what the community wanted and needed. So when we go further upstream,
it’s targeting education. And that comes from my
experience in Latin America. (light music) There has been tremendous
support behind the scenes over the years. So this is the next
stage of the build out. It’ll be a learning, education area. If you’re gonna break
the cycle of poverty, how do you do it? If somebody has an
opportunity through education that seem to me to be the place to start. (light music) – [Lou] And if you’d like to
learn more about this project, you can go on to the link
and watch the full length HBO documentary that was
done a couple years ago and you’ll find out much more detail about the facility. And you can see it’s a
fairly simple facility. It’s about 7000 square
feet, and it really starts at this kind of center waiting and hub that you see here. And it provides a range of programs. So from the clinical exam and dental that I mentioned to the
exercise and physical activity to food and nutrition
and educational programs. So this has become more
than a clinical facility. It’s become a culture hub in the community and really it’s amazing
what something simple, a found space under a parking garage and with a little creativity, with people coming together, what you can accomplish. So from a scorecard
perspective, I won’t read all of these. George will make this
presentation available to you in PowerPoint in full
length that you can followup. But clearly here one of the
keys was providing access to healthcare for this
underserved population that didn’t exist and doing it in a way based on the services that really needed. So our second story,
Lancaster General Health came to me some years ago and
said we’d like to develop a new prototype or
template for urgent care, and we’d really like to
think about this being a more retail base, kind of upscale. But this is a 5000 square foot project in a strip shopping mall kind of within a suburban context. And the goal of being
a little more upscale was to make this desirable place for folks to wanna come and to get care. And this was really done on
a pretty shoestring budget that we kinda did design build. It’s only about 5000
square feet, but we worked with a local contractor
and really were strategic about how we spent dollars
and how we chose materials. And here you can see the
reception and the waiting, and you’ll see that the
waiting is rather modest. And the reason that is
is because we kinda did a unique concept for the project to have two-sided exam rooms
with dedicated waiting, kind of a consult room
associated with every room. So you would come in and check in, and most of the time there’s no waiting. You’ll go right to a room, and you have this kind of ante room or living room outside of each exam room. And then you could come in for your exam and back for your consult. And you can kinda see the
corridor in the image there. It’s very clean because
all of the caregiving and the internal hub kind
of all the support services, are off stage. So patients really don’t see those. And you could see that
this is kinda view then looking back from the exam room into this individual waiting room. And this prototype has
been very successful. They’re replicating this
now in other locations. So here, this was the goal
of creating another access to healthcare more
closely in the community, not having to to the emergency department, but by creating a desirable
place, and the reputation that are built that people
would want to come and use it. And just about a stone’s throw away, a much different project. This is the Ann B Barshinger Cancer Center for Lancaster General
Health, which is part of the Penn Medicine family,
a number of years ago now. And this is about 75
miles west of Philadelphia and the goal was to build a cancer center in the community for advanced care, so you didn’t always have
to go to Philadelphia, but you could get this in the community. This 100,000 square foot
building from the outset, the client wanted to have an iconic shape but yet a transparent
building, one that would build a brand and a
reputation in the community. And the community really
rallied around this building contributing 54% in donor
funding for the project, and over 5000 people showed up the day the ribbon was cut, which for the size of the community is very substantial. And you know it’s clear evidence-based in the strategies that the quality of the built environment does
impact the patient experience and does impact patient outcomes. And from the outset here
at the Cancer Institute, biophilia and the introduction
of light and nature were always center and
paramount in the design. So from the time that
you enter into the lobby and then you progress back further, and you could see the green living wall that’s kind of the
touchstone as you come in for your care, and kind of lead you up to the garden I’ll show you in a minute. And you could see here in
plan it’s the radial design where all the circulation for the public happens on this short radial curve that you see in the image. And you can see kind of
these colored glass beacons kind of show you the portals
where you come in for care. And so all the exam rooms are located here on the ground floor, 38 exam rooms that are located within
a series of five pods. And each of the portals
allows you to go in without passing through another. But there are collaboration
zones for the caregivers that really provide good communication. Another important factor
was this offstage quarter to the inside where all the materials flow and supplies come in, and even a lot of the circulation and the
cleaning of soiled rooms happen in this offstage corridor. And it’s really had a very positive impact on the patient experience. We go to the upper floor now. You could see that this is
nestled around a garden. When we first started the project, part of the radiation oncology was here. And this was a parking lot
where you entered the building. We took that raised
element and made it into really the heart of the
center and the healing garden from which all of the
treatment which happens on this floor is centered
around the garden. And you could see the
infusion neighborhoods. There are four of them
with 31 infusion positions and a similar type of
circulation where you’re circulating along the garden,
and then take a portal into the various infusion bays. And then likewise, radiation
oncology very extensive and advanced modalities are all clustered in this area, also around the garden, which is very rare. As we know radiation oncology is usually on a lower level for
weight and various things and here we’re able to put
this right around the garden. So here’s kind of a view if
you’d be walking to infusion that you’d be looking
out and there’s several little portals that take
you out to the garden. And we really find that
patients and their family and staff really find respite there and frankly most of the year round. And then we also have family spaces that you see here throughout. This is a family space which sits between two of the neighborhoods for infusion. The family can gather,
and then you also see we introduced decentralized care stations between each of two
positions for infusion. You’ve seen that in patient rooms but not so often for infusion. And that really brings the care close to where your infusion’s
happening and thus allowing each of the infusion
positions to have a chair that actually allows you to look outside or move a chair to be
closer to your loved one instead of having to look back. So you could see here where
the decentralized station can look into multiple
patients so you can see and be safe but allows more flexibility for the patient and how
they want to experience their treatment. And then there are a lot of
amenities in the building and it’s something that
we thought a lot about with the client and with
the patient advisory and family advisory
group thinking about cost and thinking about what are the types of amenities that are wanted. So you can see in this image here, this is the meditation room that sits right off the garden. It’s very highly used,
and there’s a series of other things like
image recovery center, conference rooms and their art program is very extensive. They have tours where people come just to look at the art program that were produced by all local artists. So when the project was
done, we did a pretty comprehensive post occupancy evaluation and one of the things we measured is, so with these interventions,
did we get the value. Are these being used. And you can see we looked
at the percentage of times and worked through surveys
and about 18 or 19% of every patient’s visit, they’re actually using the various amenities. So at the end of the day we felt that getting a lot of input,
we really picked the right services and amenities to provide and they’re being very much used. And then there are a series
of large conference spaces which allow for clinical
interaction and tumor boards and with Penn Medicine in Philadelphia, but they also provide terrific spaces for community events, for education. They do yoga in these spaces. So they’ve really opened
this up to the community to provide a community asset. And again, we start to
think about social ROI and this is one of those examples. And at the end of the day we measured how do patients and staff, and that’s what the different bars represent. The darker blue, the staff,
lighter blue, the patients. How do they feel about some
of the overall characteristics of the building. And it’s pretty clear
that their response showed that they understood
the value and the impact that the built environment,
the integration of nature and daylight
really do play for patients. And I think studies do show
that daylight and nature do help to reduce depression,
which is specifically true for patients suffering with cancer. So the cancer center really
provides this integration with nature and I think
Dr. Oyer, in addition to talking, who runs the
center, are talking about the use of light and the outdoor spaces. He said you’ve also created a
center that the clinical team wants to work at. And the recruitment for folks coming there has been very successful
and having a facility you really want to come to every day. So if we kind of sum
up the score card here, clearly the access to
nature and the biophilia was the heart and the
center of this project. But also the social
connectedness and the way that the community really
embraced the project and supported it. So Tower Health System
is about 60 miles north and west of Philadelphia. It’s probably about 30
miles from Lancaster. And this was a new healthplex for advanced surgical and patient care. And this is a 500,000
square foot building. So a very different scale,
a very different cost, a very different location. The goal here, we created a new platform for the operating rooms, 24 rooms to provide advanced care
right in the community and 150 patient rooms that now allow the entire campus to be
a single room campus. And this is an aerial
that kind of looks over all of the campus, 46 acres, three million square feet, 680 beds. And I wanna point out that the museum and the (mumbles) Park that sits here, and we’ll come back to
kind of the important role and the connection of that community asset engaged our project. So from the onset the natural views and the understanding
of the patient outcomes and how the experience affects that was front and center and we’re all aware of Roger Ulrich’s kind of
landmark study around that. And this is an image from
the rooftop garden here, and you know this project
was certainly one where challenges, and the
solutions to those challenges provide a tremendous opportunity. So the ground floor of this
building at the entry level wanted to be 110,000 square feet. Very significant to get
all the operating rooms, emergency expansion, all
the program that wanted to be at this level. And I would be completely
foreign to this campus and the pavilion style
of the architecture. Likewise we had about
a 20-foot grade change between the entry to the
building and up to the existing campus. So we had to navigate a very
significant grade change over the width of the building. So the solution, the
opportunity was to take and create an 88,000
square foot rooftop park on top of all the prep recovery rooms, the emergency department expansion and create really heart for the project as well as a community
asset for this public. And I’ll just do that
click again so you can see this is a serious rooftop park on top of significant program. And that was really the big idea. And you could see kind of the
early concept rendering here where you can see how
this large footprint now kind of just integrates
with this rooftop park and we’re able to use skylight monitors and high windows to bring
light into the platform, and even a private garden for the surgical family waiting. But then it allows the
bed pavilion to rise up out of that and to be more in scale in keeping with the campus architecture. And I have to say, we’ve
worked with this client for many years and maybe that helped for them to take such a leap of faith to build something
significant over program space knowing potentially all the
things that could go wrong with putting a park over
top of surgical space. And this is a section that
really kind of helps you to understand kind of the
waiting and the private garden and the integration of
this 20-foot grade change to get up to this platform
level at this area of the site. And you know kind of the skylight monitors that let the light down and the variety of spaces that are in the park. So I’m gonna briefly
walk you through kind of the three ways that you
experience this building, either as a surgical patient, a visitor and family coming to the
beds, or from the community, a very important community opportunity. So from the time you
arrive at the building there’s a dedicated entrance for surgery. So that’s a very nice
asset, with valet parking as you arrive. And right as you come in the driveway, nature is very present at
your arrival to the building. And then as you come into
the kind of light-filled entrance and the use of the warm wood that you see in the ceilings, and that was a design feature that was used throughout in a number of the public spaces. And then you progress to
the surgical family waiting that you see here, and
you see the private garden that sits just outside of that. And this all-season
garden has really become a nice asset, and the
pictures here will have to go back, or the plant
material is just growing in but it’s a really lovely
kind of private garden that can be used all year round. And then as you progress from the waiting, you come in, we have all
private prep, recovery rooms. And you can see the high
clear story windows. Most prep recovery rooms
never see daylight. So not only are there private rooms for patients and families,
but natural light comes in through the clear story windows. And then we have the
centralized care stations between each of the two
prep recovery spaces, again pretty common in
patient rooms today, but not very common in
a surgical environment. And then from prep you would
proceed to the operating room and here you’re seeing
one of the more high-tech DaVinci rooms here in the building. And then you’ll come back to your recovery and you can see here is
that skylight monitor I spoke of early that lets light now down into all the spaces into recovery. So very significant
consideration of thinking about light and the surgical platform that often just does not have any. Now for the visiting family experience that you come in off of Fifth Avenue. We created a kind of a east-west connector that takes you right along
the edge of the garden on the rooftop park and
allows you to gather there and have access to the park. And then if you continue
to the main elevators which are just off the
left of your screen here, you can see that we
use the plant materials from the park actually in the graphics to create kind of good
way finding and landmarks that you could remember significant places in the building. And the patient rooms
are all light and airy and there’s a very conscious effort that the rooms would all have long views. So whether you have views across the park or you have views here looking out to nature and looking
out to the hills beyond, everything has a long view. And then the community experience. So the park here, and you’re
kinda seeing now at level and you can see kinda
the skylight monitor here has a series of spaces of upper meadow, lower meadow and a series
of the pergola you see here so you can really walk
along, find your space that’s comfortable for
you and a lot of staff and families come out
here, as well as patients that are able to. And then here’s a view of kind of along the water feature kinda
looking back to the pergola that sits behind that. And then these are just some lovely views of some of the plant material
and I’m always struck, just walk out there
different times of the year of what’s blooming and what’s there. And last year Becker’s
Review named Reading the 13th greenest hospital
in the United States as a result of the park and
some other things on campus. And here’s another view
that kind of looks back at that skylight monitor at
some of the plant material here in the upper meadow. And then here’s the path that’s leading from the upper meadow to the lower meadow and it leads down and continues the trails of the (mumbles) Park
and over to the museum that I spoke about in the very beginning. So it actually connects
back to the community. It’s open 24/7 and folks come and use that and you know I’m always struck when I look at this picture. I just wouldn’t think
that a prep recovery room is sitting below here. I might not even know
that I’m at a hospital. So again I think this
project has a significant social ROI and community giveback, and in fact, the idea of
this park and the green roofs actually helped us with
the zoning and community to be able to get a few different things of setback and height
because of the significant social and community asset
that this would create. So it’s really created
a heart for the campus, but it’s also created a strong social ROI for the community. So our last project story
is Rutgers University in New Jersey for the Institute for Food, Nutrition and Health. And this is not a healthcare building. So this is an 88,000 square
foot multidisciplinary research building that was designed to go upstream to look at
some of the health problems. And their goal was really
to create an approach to multidisciplinary work
to look at how could they look at preventable
serious but preventable healthcare problems in our society. And their goal of making
New Jersey healthy and really a model for the nation. And so they had over 100
members, nine schools and 28 different departments come together in this center. And one of the key research
areas that they started with was looking at childhood obesity. I talked about that a little bit earlier and that that’s tripled
now since the 1970s. In fact in the state of New
Jersey, 32% of adolescents between 10 an 17 are
either overweight or obese. And in Texas, that number’s 33%. So pretty close, it’s
a very serious problem. And so they took that on as one of their first study objectives. This is a section that looks through the three-story building and looks
at the range of programs. And I would note as you read
these, it’s a very unique coming together of programs
between the core research labs to multidisciplinary work environments, a humans performance lab, wet bench, even down to a preschool
and daycare center. So it’s a really wide range
of programs brought together to think about getting upstream with some of these health problems. And from the beginning
they wanted the building to be open, transparent and welcoming and we think our design was able to accomplish that for them. And you can see here on the floor plan, the real heart of this
facility is the Healthy Eating Courtyard and the Kitchen Servery. And is was very intended
to be in the center kind of nestled around
the various programs in the center. And here you’re taking
a look at the Healthy Eating Courtyard which is
used throughout the day for various meals. It’s also very popular for touchdown space and informal meetings and off times. And kind of the embodiment of the facility is really looking at the harvest grill that you see here, and they provide very good healthy foods. They bring together nutritionists, chefs, student ambassadors to really look at how they craft their
menus, and a wide range of food and smoothies. But you can’t get a dessert here. And it wasn’t for the lack of me trying. But there are no desserts here. So they do actually, as
part of their research they do study the menus
and what people eat and that’s part of the research of how to make that appealing
for healthy lifestyles. Another green living
wall that you see here, a very significant part of
the center and the stair promoting a healthy lifestyle. Things are in bloom all year long. A Healthy Performance
Lab, an important part of the center that really
looks at helping athletes to perform better and high performance. But it also looks at how much exercise and what type of exercise do we need to try to deal with
obesity, and how can we find recommendations and
opportunities to educate and to help with childhood obesity. So they work with all
the Rutgers athletes. They work with a lot of
high schools in the state, and they work with some
professional teams. So they work with the New
York Giants of football, and they work right here
with the Texas Rangers baseball team in this
Human Performance Lab. And then some other interesting things they have student health
is in this building. So you can come and it’s a
clinic for student health but it also teaches healthy lifestyles and about education and
nutrition and helping students. And then here you can kinda see the open kind of research areas, and there’s really no hierarchy between
faculty or researchers or grad students. It’s kind all a level
playing field to create that multidisciplinary atmosphere. And here are some kind
of the informal touchdown and collaborative spaces. And you can see behind
here, even the research wet lab are completely
transparent and open, and you can see them as you circulate through the building. Then the preschool and the daycare, a very unique element to have in this kind of research building. And the real focus in this is looking at healthy diet and
nutrition, and there’s a lot of education that goes on here to promote a healthy lifestyle. And the research that’s
done here is trying to go throughout the
state and help schools throughout the state and
looking at their food programs, education and nutrition,
again focused around childhood obesity. And part of that is also promoting healthy activity and exercise. So here you see the 5000
square foot playground that sits right outside the building and right outside of the preschool. So this project really hits a home run on all six of the criteria. So I won’t read all of these
but this really goes upstream to look at some serious health problems. And given that it opened
just a few years ago, they’re still really in infancy of looking at some of the research
study, and even trying to get upstream around policy. When I visited them to talk
about what they’re doing with policy, they really
said it’s something we need to more. It’s very hard, it takes time. But it’s an area that
will be very important. And again, I’ll let you
kinda read the rest of these as you go through. But I would touch again on the social ROI. Most of the food is sourced locally. In fact some of the vegetables and things are grown right on the edge of campus. So again, really a social ROI
and bringing in the community. And healthcare is a team sport. If we look at community
health and you kind of see all the disciplines
that are referenced in this chart that exist at Rutgers, but perhaps it could be in any community. But we have to really come together and it’s through a collective effort that we can make an impact
on community health. And as architects we play a role too. So at Ballinger we look at
supporting the community engagement and we’re very active. I’ve kind of talked about
the Puentes De Salud and the community design collaborative but we’re also very busy with the American Heart Association. Last year we had over 100 people come out and we raised over, the Ballinger team raised over $50,000. And Spark, we’ve been involved for years with city schools and mentorship programs. So to do this we have a program called Ballinger Flex or B Flex as we call it, which is a flex time
program that allows people in the firm and team
members to participate in these programs. And we have our Ballinger
Engage or Be Engaged which is our slogan for
our community involvement and really walking the talk. So I’d like to close with a call to action that everyone can make a difference. And as you walk out of here today, give some thought to
how can you participate, how can you contribute to
making your community healthier. Thank you. (applause) And I guess George, we have
some time for questions. – I just want to congratulate you. I think I’m supposed to speak in the mic. It was a wonderful
presentation that couldn’t have been more right on in
what we’re trying to do. And we’ve got Dr. Peter
Cash in the audience from the School of Public Health. We’re trying to make things intertwine. But anyhow, this is about
the students asking questions and so let’s start. So who’s gonna be the first student to ask a question, Margaret. – So, I’m Margaret Reagan,
I’m a senior design student in Professor Matt’s class. So with a lot of your
projects, they seem like they’re successful because they have such a diverse program. Is that something that y’all push for or that the client pushes for. ‘Cause like this last
project you showed us with the daycare and the
student health services, like the list never ended. And that to me sounds really cool. ‘Cause our student health
services doesn’t have anything near it. So I guess my question is
just, is that something y’all pushed for or is that
more what the client wants? – Well I think it’s a team effort. I think it’s certainly the client coming with a vision, and then
it’s us trying to take that vision, and be creative and say but did you think about this,
did you think about that. And I think it’s also about really getting the community involved. And many of the projects,
in fact all the projects having family and patient advisory groups and going to the community
and saying what would you like to see in the center. What’s important to you. And sometimes I think
that if we hear from them were not things we’re thinking. And so it’s really trying to go upstream and it does take a village to
get a lot of people involved. But we’re certainly an
active participant in that and trying to bring that value and ideas to the situation. – It’s definitely interesting too because y’all’s projects you said that you know you wanna get the community involved to help get the community more healthy. But I’ve seen other examples like, in our studio for example,
the project we’re working on, we’re trying to invite the
community into our building but just to kind of defeat the stigma of only go to the hospital if you’re sick. Like no, we want health
all around better wellness. I think that’s interesting
how the programs help kind of, none of these places look like a place you’d go if your sick. They look like a place that’d
be nice to walk around. – Well thank you. You know there is a
conscious effort, none of us wake up in the morning and
want to go to the hospital. It’s not something that we want to do. But I think if you have to be there, how do we make that better. But we do have examples. So with Lancaster with their art program, people will come just to
look at the art program or to maybe use the dining
and sit around the garden. So it has become a community asset. Certainly in Reading the park is open and anyone can venture into the pathways and enjoy that. So again, looking at the social ROI, looking at projects larger
than just the project, just the campus, how can we
help the community as well. And I think most of our clients
that are forward thinking think that way too. They wanna think just
beyond the immediate need. Thank you for your question. – [Margaret] Thank you so much. – Lou, that’s an impressive talk, and I really enjoyed that. I have one question
because it’s my second time to see the hospital with
a huge rooftop garden. That’s impressive. And then you introduced the greenery and also natural light
similarly integrated with the building itself,
that’s incredible. And then we have all those
vegetations on the rooftop and also you know people
can see the greenery in the summer, in the fall, in the spring, that’s great. But how about in the winter? Are they all brown right now? – No so we work very carefully
to have it all season. And the plant life is picked. We have grasses and different things that will last all year long,
different plant species. And it’s actually interesting. We have a lot of
sustainability on our projects. At the upper garden at Lancaster you saw we actually have rain leaders
that capture everything in a cistern, and in
the winter they freeze and create these just
beautiful sculpture pieces next to the building. So you know that was kind of unintended. Who knew we would get that out of that. But we really are
thinking, how do these look good all year around. We don’t want just part of the season. Certainly in the northeast
we get cold winters, a lot of snow, so we do have
to be very mindful of that. And I would not at
Reading when I said take a leap of faith and the big
park that you see there, you know that isn’t the normal sedums that are done in just thin trays. So we had to engineer very carefully with some specialists to
look at using three, four, five foot of styrofoam
and different materials to be able to get enough depth to have serious trees and plant materials so it looks like a
park, not just the trays of the sedums. And so there was a lot
of technical details that we had to do on waterproofing and a lot of things that if you were in the symposium last fall, we gave a talk on the whole technical
aspect with the client of what could go wrong, what do we have to think through. So there is a lot of
thought to doing something kind of that intensive for the project. – It’s great to know. And then my next question
is that how about the maintenance cost
and also the first time you (mumbles). Does that significantly
increase, then how’s that percentage. – So the client at Reading
and all of our clients go in when we look at what is going to be the budget for maintenance. And then go in and they
have to be committed to that budget. And also that the first year or two, you’re getting everything going. So there’s extra effort to
get everything established. So I think by being
transparent, by working with the right specialist, and the owner kind of understanding here’s
what I’m getting into. ‘Cause when things don’t
work is when there’s not good communication
and then you don’t have the maintenance budget, and you look out and everything is brown. But I know as one CEO said to me, he said Lou, you know when I
look, there’s a very fine line between natural and just chaos, just where it looks like too sustainable. And so there is that
fine line that you look at in these projects. – [Lou] That’s great, thank you. – Thank you for your comments. – Any other questions? I would like to make one observation about your presentation that
you, by introducing words with very fine photographs,
you spark the imagination of your clients to think about things because some clients can’t,
even if you show a photo, really relate or imagine
it in their building. But the words with the
photo, I think are a very, very effective way of presenting. So this is terrific, and
Lou took a whole day, two days to fly all the
way down from Philadelphia, and welcome, we arranged
some nice weather for ya. – You sure did George. – So with that our officer from SHEA our Student Health
Environments Association, Louis Garabag wants to
say a few closing words. – I’m very impressed with what you and Ballinger are doing. I think it’s really great and on behalf of Texas A&M, SHEA and the
College of Architecture, we’d like to present you with this gift. – Well thank you very much. – I appreciate it and
thank you for your lecture. – Thank you. (applause) (light music)

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