The ongoing COVID-19 crisis poses many concerns for the healthcare industry, challenging best practices and the built environments that support them. [This] is the third and final part of [Center for Health Design’s ‘Voices of the Industry’] series where we share experiences, insights, and expectations among those who are the experts in the healthcare and design fields. Hosted by Thomas M. Jung, RA and featuring Lionel Ohayon, Founder and CEO of ICRAVE; Dana Boyd Barr, Research Professor and Faculty Environmental Health, Rollins School of Public Health, Emory University; Hank Adams, AIA, FACHA, EDAC, Global Director, Health, HDR.

The video recording of this conversation can be viewed below or at Center for Health Design’s ‘Voices of the Industry’ series.

Tom Jung: 00:01:25 Hello, everyone. Welcome to The Center for Health Design, Voices of the Industry series. Thank you for joining us. I'm Tom Jung, a member of the board of directors for The Center for Health Design and your host for today's session.

Tom Jung: 00:01:38 We're so pleased that many of you have decided to join us for this important dialogue. The ongoing COVID-19 crisis poses many concerns for the healthcare industry, challenging best practices and the built environments that support them. Clearly, we have a lot to consider since this all began back at the beginning of March.

Tom Jung: 00:01:57 Today is the third and final part of our series where we share experiences, insights, and expectations among those who are the experts in the healthcare and design fields.

Tom Jung: 00:02:07 Our first session in May focused on our industry's immediate response to the pandemic. In June, our second dialogue reflected upon lessons learned as COVID continued to cycle through the various regions of our nation and the world. Today, we will ask our panel to consider how this global health crisis might impact the future of our industry in terms of providing healthcare as well as designing the built environments that supports those activities.

Tom Jung: 00:02:33 This discussion is typical of the work of The Center for Health Design, which seeks to gather great minds to project future developments and innovations that often have a ripple effect on the industry. As you know, the center has been instrumental in pioneering the concepts of environment of care, person centered care, and evidence-based design.

Tom Jung: 00:02:52 This series of dialogues supports the center's expanding view of healthcare as just one element albeit a critical one of overall health. Overall health is a critical component of our culture, and this COVID-19 crisis highlights how the concept of overall health has implications for virtually the entirety of our built environment.

Tom Jung: 00:03:13 Here is how we have designed the workshop experience to happen. Throughout our discussion today you will have the opportunity to pose questions to our panel. When you click on the Q&A pod located at the bottom of your screen, you will be presented with a window into which you may type your question. We have set aside a block of time towards the end of our session to share some of your questions with our guest speakers.

Tom Jung: 00:03:40 Continuing education units are available for this webinar from AIA and EDAC. To receive credit for your participation, you can download the forms by clicking on the chat window. There will be a Dropbox link where you will find access to the CEU forms and a form to request a certificate of completion.

Tom Jung: 00:03:57 For AIA credit and a certificate of completion, complete the verification forms, purchase a CEU management fee from CHD store, and submit the verification form to Natalie Gonzalez. You'll find Natalie's email included on the form.

Tom Jung: 00:04:12 For EDAC credit, complete the verification form and retain it for your records. You will need to report the credit to Scantron at the time of your renewal.

Tom Jung: 00:04:22 Before you meet our panelists, I want to thank Patcraft whose generous support has made this series available for you. They are to be commended for stepping up in such a timely manner to ensure that developing and late breaking information from the field could be shared with you literally as this crisis was developing and ongoing. Can't say enough about their commitment to our industry and continued safety and well-being of us all.

Tom Jung: 00:04:49 Now, it's time to meet our panelists so that you, the audience, can get to know our guest speakers a little bit. I'd like to ask them each to take a couple of minutes to introduce themselves, highlight what they do, the perspective they're bringing to our discussion today, and perhaps one key observation they may have due to these challenging times. Let's start with you, Hank.

Hank Adams: 00:05:14 Okay, thank you, Tom. Hello everyone. My name is Hank Adams and I'm the Senior Vice President with HDR and I'm located actually here in Dallas, Texas. I'm a career long healthcare architect. My perspective on today's discussion is going to be through the lens of design and as an architect, I'm also a fellow in the American College of Healthcare Architects as well.

Hank Adams: 00:05:38 My role with HDR is that I lead our global health practice. At HDR, we have a multidisciplinary architecture, engineering, and consulting practice that is focused on creating healthcare environments really throughout the world. We're based out of the U.S. but we have offices throughout North America, Europe, Middle East, Asia, and Australia.

Hank Adams: 00:06:01 Our practice also includes another sector that is closely aligned with our healthcare practice and that is our education, science and technology practice. Because of that, our firm focuses a lot on academic medical centers. We focus on translational research and bio containment type of facilities. We really have been spending a lot of time focusing on really the changes in healthcare and research associated that are coming from the pandemic.

Hank Adams: 00:06:31 From my personal perspective, over the course of my healthcare design career, which spans about 35 years, I've seen a steady evolution of healthcare facilities and healthcare delivery models that have moved to being far less institutional, more personalized, and more integrated throughout our lives. That's all been a very good thing, but it is a slow process.

Hank Adams: 00:06:57 I think what I recognized with the COVID-19 pandemic has been an inflection point in that process and I believe has disrupted and changed almost all the perceived norms that we now have for healthcare delivery. While this pandemic will eventually pass, I do think it will present an opportunity for us to rethink and reimagine healthcare delivery and what that might look like going forward.

Hank Adams: 00:07:24 Excited to be part of the panel today.

Tom Jung: 00:07:27 Thanks, Hank. Dr. Barr, would you please introduce yourself to our audience?

Dana Barr: 00:07:31 Yes. Hi, I'm Dana Barr. I'm a professor at Emory University's Rollins School of Public Health here in Atlanta, Georgia. I have a previous career of 23 years at the Centers for Disease Control and Prevention as well. I'm a public health scientist with an environmental epidemiology and exposure science background. My research is primarily focused on maternal-child health, getting into some air pollution activities, and now with the pandemic, I'm looking at disease ecology and factors that affect disease transmission. Specifically, I'm working on COVID transmission and how that transmission can be altered or exacerbated because of air pollution.

Dana Barr: 00:08:17 I'm really amazed at our resilience during this time. We've been able to adapt on a dime here and change our directions of conducting business, our ways of doing research. And I'm really impressed with our ability to do that. I think our adaptability and our ability to do that will serve as well in the future.

Tom Jung: 00:08:42 Great. Okay. Thank you, Dr. Barr. And Lionel, would you like to complete our introductions today?

Lionel Ohayon: 00:08:48 Certainly. Thank you, Tom. My name is Lionel Ohayon. I'm the founder of ICRAVE. We're a multidisciplinary design and innovation firm based in New York City. Our work has brought us across many industries, but really in the heart of what we do is understand the experience of place and try to apply learnings into reinvention. I think it's pointed that where we are right now and trying to understand how do we reinvent ourselves and what do we learn through what we've been through and carry that forward into new realities in the built form, in the digital interface, and the operational models.

Lionel Ohayon: 00:09:23 We were introduced into healthcare through Memorial Sloan Kettering about eight years ago and now, we've completed several projects with them. Part of our challenge when we start with them is can we reinvent the way people experience cancer care.

Lionel Ohayon: 00:09:36 Our perspective and what we're bringing to this conversation really stems around the idea that if people are in buildings that are actually designed to be part of your cure, we might be able to look at the entire circuit of someone's lives not just as a patient but as a human being, as a father as, as a positive person in the workforce, and trying to understand how all those different parts are affected and how we can reinvent it across all channels.

Lionel Ohayon: 00:10:04 Thank you.

Tom Jung: 00:10:06 Excellent. Thank you, Lionel. Finally, I'm Tom Jung. I've spent virtually all of my 30 years of experience as an architect overseeing planning, design, and construction activities for healthcare facilities in the state of New York. I retired from public service in 2011 and since I've been focusing on my work with the center, both on the board and helping to chair one of the volunteer committees.

Tom Jung: 00:10:32 I've witnessed this pandemic from the sidelines and, frankly, I'm not surprised to see the level of innovation and commitment that's been exhibited by my respected friends across the industry.

Tom Jung: 00:10:44 But one observation, I guess, that I have is the probable impact of this crisis and its effect that I believe, I'm sure we all agree now, on our entire built environment, not just healthcare facilities. That means that literally all of you who might be tuning in today will potentially have a role in addressing the issues raised by this pandemic. Because while we historically and we continue to design structures for shelter or to allow us to interact or to allow us to be productive in our activities and even to help us relax, we now also may have to give attention to how our structures protect us or at least don't endanger us.

Tom Jung: 00:11:30 I was taken with Lionel's comments about the experience and his work with Memorial Sloan Kettering on that because I truly hope and I'm sure the center will be following this as well as all of you who follow our work is that there will be a focus on infection control and issues like that, but hopefully, they will not override our concerns and our understanding that the experience is really critical, experiencing an environment to healing and to how we react. Hopefully, we won't overlook that critical component of design. I'm sure we won't.

Tom Jung: 00:12:09 All right. Now, I think it's time to get started.

Tom Jung: 00:12:13 Panelists, as you look back on the past five months of this pandemic, how have our expectations for healthcare changed and what key differences from traditional elements of care delivery might shape the future of health and healthcare?

Tom Jung: 00:12:28 Dr. Barr, would you be able to lead us off on dealing with this question?

Dana Barr: 00:12:32 Yeah, I definitely would be.

Dana Barr: 00:12:34 One of the key differences that I've seen from a public health [inaudible 00:12:38] is we always envision clinical care as being very personal and one on one and it continues to be, but I think now, this clinical care is put in perspective of the public health. We have to consider care services and different things that we did and behaviors that we adopt and how that relates to overall public health.

Dana Barr: 00:13:00 I think that we've seen the capacity of our testing systems overburdened. I think we haven't really tested them to this extent before and we need to have more innovative ways and quicker ways of getting testing done.

Dana Barr: 00:13:16 But I think one of the biggest changes that I've seen, I think a lot of other people have seen, is this burgeoning of telehealth. Telehealth is not a new concept. It's been around for a long time, but it's been practiced primarily in remote regions or in areas that are hard to get access to individuals. But I think that we've demonstrated that we can have good and responsive healthcare even if it's just through internet services. I think that that's one key difference I've seen.

Dana Barr: 00:13:51 I think the fact that we have drive-thru services is something new. That something that hasn't been done in the past. Normally, you go into the clinic, you get a blood sample drawn, you get a urine sample, and they give you your test results three, five, 10 days later. Now, we have the capacity to do drive-thru testing of nasal swabs and you can get rapid results in minutes with confirmatory results several days later. I think that this is definitely something that is new and probably could continue for years to come.

Tom Jung: 00:14:27 It's interesting. I'm just thinking as you're speaking about how technology transfer is truly here. Drive-in banks have been something for quite a while where you could rather than go to the bank, you could just drive up to a window and do your transactions that way. Our bank here locally and all the New York is starting virtual tellers. You can literally log in to the bank and you will be connected just like this with a teller and you can do your transaction while you're actually speaking with someone. It's interesting that I think that there's a lot to be learned from both industries probably and I'm sure they'll be sharing regarding that.

Tom Jung: 00:15:06 Would anyone else like to respond to that question? Hank?

Hank Adams: 00:15:13 Yes, Tom. I might add on a little bit more to what Dana shared.

Hank Adams: 00:15:18 I think the pandemic has in many ways out of necessity forced us into the virtual world more than we would have ever done on our own, without having the pandemic of being the catalyst for that to happen. I think you're exactly right in that telehealth is something that the industry has really embraced for a period of time, but not at the scale that we're seeing right now.

Hank Adams: 00:15:46 In looking ahead five years down the road, 10 years down the road, I think that this experience is about getting us more comfortable with the virtual environment in terms of how we interact with our healthcare systems, how we share data, how we track data. I know that contact tracing is something that maybe more prevalent in the future because of pandemics and trying to understand how they spread.

Hank Adams: 00:16:12 But the really big idea here is the fact that I think that the virtual environment and how we use data and how they data is going to inform our health delivery, and also, our public health policy and things like that I believe are going to be accelerated in a way that maybe weren't before.

Hank Adams: 00:16:37 The benefit of that is, I think, it's going to give us more and more of an opportunity to move the care setting closer to home or at home and frankly, the hospitals are going to be the last venue you really would be needing to go to for your typical routine healthcare. I think this is really going to really push us towards getting to that utopian situation faster.

Lionel Ohayon: 00:17:01 That's really a great point. That's really what I was going to speak to is this idea that behaviorally this pandemic, really, when you look back at what the most important prevention was washing your hands. These are behavioral things that everyone can do and take responsibility for personally that are massive firewalls for people understanding of where are we safer and where are we less safe. We've heard this term, "You get sick in hospitals and you get well at home." This pushed to get whatever you can into your own space.

Lionel Ohayon: 00:17:35 This idea that so many of the things that we'll be able to do, we'll be able to do in our private spaces has to be unlocked by this license of people understanding that it's your own behavior that's going to protect you, that means washing your hands or wearing a mask or eating healthy, or exercising or whatever that might be that the gaze gets turned from the professional in a white coat or to the lab and it gets turned back at yourself.

Lionel Ohayon: 00:17:58 Once that happens, I think the opportunity for a lot more trust to happen for people to do it from home is going to be accelerated to a point where we can start to see a lot of the burden taken off the facilities and maybe even a lot of the costs changing and people doing a lot of that from home which I think will be great for everybody in the country.

Tom Jung: 00:18:20 It's interesting you three have had very specific ideas about how healthcare might change, but I also sense some uncertainty there. This is probably directed to you, Dr. Barr. There's some uncertainty because while behavior is very important and we need to understand how to design facilities for revised practices and procedures in healthcare facilities themselves, things will move out of healthcare facilities, as you say, Hank.

Tom Jung: 00:18:50 Dr. Barr, I think there's a lot we don't know about what's happening and I think there's a lot of confusion as to whether it's in the air, whether it's contact, the exact... I think that's the point you're getting about how public health would be so critical. If you could expand upon how important that information will be because we can't change procedures and we can't redesign facilities or our expectations unless we know exactly what we're dealing with and granted, this is only one issue, this COVID-19. There certainly will be more, but it certainly tells us that we need to better understand this emergency so that we can adjust our behaviors and our facilities accordingly.

Dana Barr: 00:19:31 Yeah, I absolutely agree. Even within the scientific community, there's a lot of conflicting information. In one day, we get information that saying that COVID is only present in the smallest droplets that can lodge deep into your lungs and some say that it can be universally spread throughout a room if you're speaking or if you're singing but not if you're just breathing or quietly talking.

Dana Barr: 00:19:55 I think that there is a lot of conflicting information because it is a new disease and we are learning a lot about it as we go along. The scientific process is really working through some of these things is there will be conflicting information and ultimately, the preponderance of information will finally coalesce, hopefully, and we'll get some coherent results.

Dana Barr: 00:20:17 I think this behavioral change is a really interesting thing because I think it's going to have implicate... Not think, I know it's going to have implications on other diseases and I think we'll get a lot of positive feedback from that. When people see that washing their hands and staying at home when they're sick and trying to distance themselves from others when they can will also prevent common colds, will prevent a lot of sinus and prevent flu transmissions. Already, we have lower incidence of flu right now than we have in previous years. I think that there are broader implications of some of the behaviors that we're adopting right now.

Dana Barr: 00:20:53 But I think that we need to continue to study it. A particular concern to me is the particle dynamics in a room and how they do spread and are you safe in an enclosed space with just a few people or are you safer with a larger number of people in an outdoor space. I think that's very important.

Dana Barr: 00:21:11 Moving some of these services to alternative facilities, moving them to home or moving them to non-hospital or non-clinic based facilities, I think, is a great idea. Being able to self-administer a lot of treatments is great. I think it's going to require though that we educate the consumer or the person that's getting the healthcare a lot more so they understand why they're doing what they're doing and why it's necessary. That probably is going to have to be paralleled with some increase in innovative technologies that are a little bit more foolproof so you can have them at home and don't have to worry so much about not being able to operate the IV unit properly or something like that.

Tom Jung: 00:21:58 Good. Let's move on to another question and that is, based on our collective experience with this crisis, what are the new horizons for the next generation of healthcare delivery settings? This relates a little bit to what we were just talking about. For example, are there things we see now that we didn't recognize previously that might be possible if we explored them with fresh eyes? Hank, can you start the discussion on this?

Hank Adams: 00:22:32 Yes, thanks, Tom.

Hank Adams: 00:22:34 As I ponder the question, where I've been going to is this whole idea about resiliency planning and thinking about our health system and the resiliency that's embedded within that system is based around a lot of different threats that we typically had been focused on in the past and [inaudible 00:22:55] threats typically is around things like mass casualties, natural disasters, whether the weather events or earthquakes and floods and things like that, there's some security issues related to civil defense and how we might build a facility or design a facility to be resistant. And then of course, climate change is something that's been certainly a focus for a long time.

Hank Adams: 00:23:18 But from my perspective, what's really happened with the pandemic is it's really upended all that. It's added a layer of a new threat that frankly the entire industry has not had to deal with before. Those ideas about having facilities that are contaminated that suddenly have the virus throughout them and that you've got to manage all the occupants within that.

Hank Adams: 00:23:46 There are disruptions to supply chain that we saw that happen throughout this pandemic, medical equipment shortages, personnel and staff issues and shortages during peeks and then if you think about the virtual world, the fact we're so dependent now, we're using so much telecommunications and telehealth now, cyber and business disruption comes into play. And then overlaying all that is the financial impact that the pandemic's brought.

Hank Adams: 00:24:15 From my perspective, I think that it's going to make us think about how we design and plan and maybe my frame of reference right now might be just acute care hospitals, but really how we think about planning and designing those for the future considering all these different threats and risks that they have to face. They're very complex systems. They go into hospitals and I think, as a design profession in particular from my vantage point, we really have to think a lot about what the facility in the future might really look like and what systems need to be permanent and what need to be scalable or hierarchical as a threat emerges or as a threat grows.

Hank Adams: 00:25:10 I think that there are lots of established networks and partnerships in the industry that can start to help our clients sort that out and understanding a way to design for resiliency maybe we just haven't had to deal with in the past. But for me, that's been a high level thing that I think we need to be focused on as we look forward.

Tom Jung: 00:25:35 It's interesting that you talk about hospitals of the future. That's something that we've discussed in the industry for probably decades that we're always looking for the hospital of the future. Do you think that this crisis has heightened the urgency to consider? I guess that's really what the core of this question is, right? What is going to be in the future?

Hank Adams: 00:25:59 Yeah. I think it's heightened now. Just one thing I wanted to mention as well is I think that there are aspects of this question that have been dealt with at a global scale and certainly, there are countries... I know in the previous sessions for the series, there was a lot of discussion about lessons learned from Asia where they dealt with previous pandemics and outbreaks. There're lessons learned from Europe and Canada and others.

Hank Adams: 00:26:24 There are countries that have developed really complex systems to address mass casualties and civil defense. For instance, the hospitals that we see sometimes in Israel where they might have parking garages that can be converted to patient use and things like that.

Hank Adams: 00:26:42 I think this notion of having a flexible, adaptable platform for healthcare delivery and one that is resilient to these risks and it can be scaled up in a way that is cost effective and is smart and doesn't overspend resources in doing so is really at the crux of this idea that we need to look to for the future.

Tom Jung: 00:27:09 That's interesting. I'm not going to put words in your mouth but I hear you talking about how we need to look at facilities differently and I'm curious, and Lionel, I'm going to direct this to you, I know that you focus on user experience. I've worked with Memorial Sloan Kettering and I know because of their specialty, they're very attuned to user experience. Is there anything in your experience working with them recently that highlights maybe we don't need to do things the same way we've done and maybe we need to do them a little differently?

Lionel Ohayon: 00:27:43 Look, to their credit, they really are an innovative group who are looking for innovation and change and forward thinking. A lot of our work that we've been able to come into this industry with to their march forward.

Lionel Ohayon: 00:28:03 A couple of things are encouraging about what we're talking about. The sense that the hospital serves a purpose in a pandemic, in and of itself, is on the table as a question. The hospitals are not built. I happened to be Canadian and in America, specifically, the hospitals are not built to serve a greater need necessarily in a way that they can absorb the impact of a pandemic.

Lionel Ohayon: 00:28:29 Having said that, we just opened the Koch Center for Memorial Sloan Kettering in, I think it was November or December, and this pandemic happened and they made no changes to the building. Because of the nature of what type of building it was, they are already acutely aware of transmission of germs. That had already been baked into the solutions for the building and there are very, very minor, very, very minor things that we're looking at right now that might be implemented.

Lionel Ohayon: 00:29:00 I don't think this is going to make us... It's not going to be because of the pandemic that we will solve for the hospital of the future. What we do have an opportunity to do as a society is to hit a reset button and say, "If pandemics are part of our world and our government is part of our solution set, we're talking about 140,000 people who are dead now, if we attribute that tally to this pandemic, then it's almost a national defense issue." There's a budget for national defense. Are we willing to say part of that budget becomes part of our solution for how we address pandemics?

Lionel Ohayon: 00:29:43 If you follow me on this one, the intent to understand that is to say, "If hospitals serve a purpose for the everyday and people need to have surgery and people have other things that they need to be in the hospital for, what is the impact of all those people not being able to go to hospital over the last five months to absorb the impact of the pandemic and can we absorb that pandemic need somewhere else?"

Lionel Ohayon: 00:30:05 It's big thinking. How does society change? How do our cities change? What are you doing in the instance of a pandemic?

Lionel Ohayon: 00:30:14 One of my civic responsibilities as an individual, now we're trying to find tracers and we're trying to find people who have different roles when the pandemic hits who could deliver food to the needy. All these parts that need to solve for a system that doesn't break down and then a built form which could be community services buildings that in times of pandemic instantly transform and we're not putting people in garages and in bomb shelters or whatever.

Lionel Ohayon: 00:30:43 I come from an innovation side and for me, the best outcome here is a massive reset on what is the responsibility of our government, our leadership, our nation, our citizenship to look at something like this so it can be reinvented. I think there'll be a lot of talk and a lot of thinking about that and not just assume that everything goes into the existing hospitals and they're somehow magically going to figure it out.

Tom Jung: 00:31:14 That's interesting. It reminds me of something that Dr. Barr said in response to the earlier question about the importance of public health.

Tom Jung: 00:31:23 I guess my question is, and this is from my experience, albeit limited experience, as a regulator in state government overseeing healthcare development, but typically public health and hospitals or ambulatory facilities only cross paths when we talked about populations at risk, populations that didn't have the ability to have primary care physicians or were unable to follow healthy socioeconomic conditions dictated that they had various health conditions that we were concerned about. We asked hospitals particularly from their ambulatory perspective to go and try and address these issues and that's great.

Tom Jung: 00:32:06 But it seems to me now that more people, if you go out on the street, are talking about health. Regularly, the majority of people weren't concerned about health. It was something that if they got ill or they had a doctor's appointment, but every day they weren't thinking about it. Today, we feel like it's on everyone's mind.

Tom Jung: 00:32:23 Dr. Barr, what do you think about the role of public health going forward in terms of addressing more of an awareness of health today in our environment?

Dana Barr: 00:32:35 I think you hit the nail right on the head there. I think that clinicians and public health scientists have only talked when it's necessarily talk. I think now is a clear opportunity to really public health into personal clinical care as well. Actively collecting surveillance data that can help evaluate and assess emerging diseases that we might not know about, collecting information on unusual symptoms or groups of symptoms and sharing that with public health scientists. I think there needs to be two-way crosstalk.

Dana Barr: 00:33:09 And then public health scientists need to be better at implementing and in transferring their science into clinical help applications. I think that's something that's very necessary.

Dana Barr: 00:33:22 You see, in some hospitals, they might have an isolation ward for some very bad disease like Ebola. We have an isolation ward at Emory for that and that requires some coordination. But in general, I think it's been lacking. I think the fact that we're talking about public health is good.

Dana Barr: 00:33:41 As Lionel had said, we're adapting these behaviors that are very beneficial, wearing masks, washing our hands, which we've always known is good, we just haven't been practicing as effectively as we needed to. I think making people more acutely aware of this and seeing what can happen if public health becomes disastrous like it has in this pandemic, that people will adopt these behaviors and keep them in order to be more protective of their own health and the health of others around them.

Tom Jung: 00:34:15 I think this is a perfect segue into our third question because we're talking about an increased awareness to the general population of healthcare because of this pandemic. I'd like to ask you all, how has this pandemic changed what we know and understand about healthcare? And will it influence other environments moving forward including education, our workplaces, and community facilities? Lionel, what are your thoughts regarding this?

Lionel Ohayon: 00:34:44 I think it's definitely influencing other parts of our lives. When Dr. Barr was just talking, I was thinking about the fact that we're now implementing hand washing station as a ceremonial event entering restaurants. There's a certain point and so what are you going to do?

Lionel Ohayon: 00:35:08 We design these beautiful restaurants in New York and L.A. and around the country and you can't just make it a clinical hand washing station. It needs to be this beautiful ceremonial thing with aroma therapy and make it almost like a shame barrier. You have to walk through this thing to get seated and it's got to look cool. It's got to be appetizing and you have to be able to not tell somebody, "Please wash your hands before you come to my restaurant."

Lionel Ohayon: 00:35:34 We have to figure out how to design intent so that people are nudged a certain way and then you're like, "I'm not going to have washed my hands." And someone's going to put a menu in my hands because who knows where that menus been. You start to see tiny implementations of process that we've lived with for a long time that seemed normal things that you do every day when you go to a restaurant or when you check your kids into school or for example, on airplanes.

Lionel Ohayon: 00:36:04 I was having a talk recently about what we can imagine the airports to do. We do a ton of airports and we've implemented tens of thousands of iPads in airports which are problematic because their screens people are touching and what do you do and how do you transmit disease that way. But we start to look at the gate hold... The problem that we have on airplanes that everyone perceives the airplane as the dirtiest place to be. It's not that it's dirty. It's the highest opportunity for you to get something like COVID-19. How does the airline and the airport industry change that perception so that it's actually the safest place to be?

Lionel Ohayon: 00:36:47 There's been such a clear indication and screening and a process by the time you get on the plane that you know that when you're on that plane, you're in a safe haven.

Lionel Ohayon: 00:36:56 Cruise ships have the same problem. You got to change the perception from, "This place can transmit disease," and there's been breakouts on them to, "I'm safe. I'm at sea. Everything bad's happening behind me." Those are other complicated processes that have to be implemented. But they're going to have to be implemented for people to travel the way they have, for people to cruise the way they have.

Lionel Ohayon: 00:37:17 You're seeing tiny things as small as, "We're not going to have paper menus, how am I going to explain what we have to eat," or "I got to get people to wash their hands but I can't be rude about it," all the way to the gate hold on an airport is now a white sanitization last moment before you get on the plane, you know that everyone who's passed through that gate hold has been through a cleansing or a screening of some sort.

Lionel Ohayon: 00:37:46 It's profound in a way it's going to change actual physical implementations of space, not to mention, what is the future of commercial space at all. How many people are just asking the question, "If I double the size of my business, do I need to take one more square foot of office space?" I think that those are also on a different end of the impact of COVID-19, profound questions about the future of cities. I'll even start with retail because that's a whole other disaster.

Tom Jung: 00:38:16 Interesting. We talked earlier about we would be looking at processes of healthcare going forward when we talked about the future of healthcare facilities and I think I've heard you say previously, Lionel, that when you think about waiting in a healthcare facility is not only time consuming, but now people consider it potentially hazardous to their health. This is for all the panelists, do you all think that we're going to be looking at processes through all of our culture, through all of our facilities? You mentioned retail. What about offices? What about schools? Are we going to be looking at changes in process that are going to require design changes as well?

Tom Jung: 00:39:01 Hank, you're nodding yes.

Hank Adams: 00:39:02 Yeah. I would love to weigh in on this because I do think that we have, as designers, a responsibility, if you will, to make sure that we have safe communities and safe urban environments. One of the major issues that the pandemic has really impacted is this question about density in these really dense urban environments knowing that we have to depend on things like transit and the flow of people is more constrained. Is that more dangerous?

Hank Adams: 00:39:38 With your comment about can we apply healthcare thinking to other systems in our communities, one area that we've had the benefit of doing at HDR is that we have a group that does a lot of work into transit space and works for all the different kinds of transit modes out there from subway to light rail to bus service, etc., and in aviation. After the pandemic started, they invited us to get involved in an effort that a number of their clients were asking and said, "Can you take a look at the problems we have with transit and the concerns we have through the lens of healthcare? What's your approach? And how would you look at it differently?"

Hank Adams: 00:40:26 What that did is it gave us a chance to look at transit from that viewpoint as we would in the hospital of disease transmission. What are the fundamentals of disease transmission? What's aerosol versus contact distribution of pathogens? And then start to peel back as we look at healthcare facilities where you start to think about the technical aspects of it, the operational aspects of a transit, and then the behavioral aspects of it. That started to create a lot of different thinking for our clients that they traditionally had not really had to wrestle with because of the pandemic.

Hank Adams: 00:41:08 What we'd come up with is this idea that you'd almost treat it like you would a hospital where you have different risk profiles that would be elevated over time. That would allow you to continue to have transit be open because it's an essential service and people rely on that in our cities. It's a vital aspect to urbanization, it's vital to climate change and everything else. They could somehow adopt the technical, the operational, and the behavioral approach depending on what the risk level was, whether it be low and normal, under normal circumstances to what we have when we have a lockdown, and then maybe even a stage in between.

Hank Adams: 00:41:52 A lot of the thinking and a lot of the processing that we do in our healthcare, not only design, but also in how we deliver healthcare that we can apply to other industries and start to really help make those more resilient as well.

Tom Jung: 00:42:10 Before we continue with this, I just want to remind the audience that we will be taking questions after this. If you have any questions for our panel, please don't hesitate.

Tom Jung: 00:42:19 I'm hearing a common theme here when we talk about other types of facilities besides healthcare. One of the things that seems to stick out my mind a great deal is behavior. It's how we all will behave, and I'm wondering, this COVID-19, to me, anyway seems to be from what we know and this is from the public health side, Dr. Barr, that it's most of a concern for those either older or those who have preexisting condition.

Tom Jung: 00:42:47 I'm wondering if concern over behavior combined that with health will result in a concern and maybe our population will want to be healthier? Public health issues will maybe come to the forefront. Maybe there'll be increased public health pressure on good behavior and things of that nature because obviously, if something like this comes along again, those are the folks that are going to be most at risk. Will this shine more of a light on a healthier population do you think?

Dana Barr: 00:43:20 Yeah, I think so. You talk about risk and in public health, we speak in risk always. If you're around a dense population, your risk of disease transmission, whether it be COVID or any other disease, is much higher. If you're in a less dense population, it's slower. If you wear a face mask, you're reducing the risk. If you wash your hands thoroughly multiple times, you're reducing the risk. If you have a healthier lifestyle, if you exercise, if you're not overweight, you're reducing your risk.

Dana Barr: 00:43:52 I think it's important for people to remember that there's not just one panacea here, that we really have to combine behavioral changes, engineering design as was stated, early operations, all of those to reduce the risk in various steps.

Dana Barr: 00:44:15 I've heard a lot of people say, "If mask work, why are we social distancing?" Or "If social distancing works, why are we wearing masks?" "And if mask works, why aren't we just going back to school as normal?" It has to do with this risk. Obviously, if you're in a more susceptible population, you're elderly or you have a preexisting condition or you're immunocompromised, your risk for developing disease if you're exposed to that pathogen or that virus is very high.

Dana Barr: 00:44:43 Yeah, I think it will help us to rethink our own individual health and how we can reduce our own personal risk just by becoming more healthy and adopting more healthy behaviors.

Tom Jung: 00:44:56 It's interesting when you go now. I just stepped into a restaurant yesterday to say hello to someone who runs it and I hadn't been in it since December probably. I was amazed that all the walls and Plexiglas panels that had been installed. It was incredible. You see more and more of that. You go to the grocery store.

Tom Jung: 00:45:16 Let's fast forward a year and a half from now and the pandemic is now, hopefully, in our history and things have returned relatively to normal. Is the urgency still there, do you think? And do we need that urgency in order to activity, in order to innovate? Or do you think we're going to lose some steam once this starts to abate?

Lionel Ohayon: 00:45:37 I think if in a year and a half, I hope, that you won't be thinking about it, talking about it, it won't be in your everyday life. You'll be behaving normally and I do not think that people will never be in a packed bar again or that people won't go in the restaurant, eat, and the spacing that they used to go or nightclub or airport or whatever it might be.

Lionel Ohayon: 00:46:00 I think that we've been thinking about it with our clients about now and when everything's back to normal. But I don't think that implies that there won't be changes. I just think that this notion that we're going to be compartmentalized for the rest of our lives is not realistic. We shouldn't think that. We should aspire to going back to normal, figuring out how to get there, and figuring out how not to fall into chaos again. These things will come up again. The question is when they come up is we learned an important lesson.

Lionel Ohayon: 00:46:35 It's chaos right now. We don't even have a national discourse on what is actually happening around us. There's probably three different discourses that are clear, different paths of where we are and what we should do.

Lionel Ohayon: 00:46:47 I hope that in a year and a half from now we have found solutions for delivering on public health in a meaningful way. We have found solutions, I think, [inaudible 00:46:58] but the most important thing in the city like New York and the density is a subway system. How do you build that trust to be in the subway like that again?

Lionel Ohayon: 00:47:07 To me, again, I want to go back to the opportunity. The opportunity is to set a course for what we do if this happens again in 10 years, five years, 50 years, whatever it might be, along the way, we've already learned that we're going to have a healthier population. People are going to take more direct control of their health. They're going to live healthier lifestyles. Hopefully, they'll just wash their hands and we'll have less flu and less cold. It's already a huge benefit to our society.

Lionel Ohayon: 00:47:34 I think that one thing we didn't talk about is personalized health. This idea that there's a health solution specifically for me. Right now, people, they go and get a juice or a smoothie because it's healthy. But we're working on smoothies that are specific for you that might be reactive to exactly where you are that day. You might be okay to pass on your saliva that moment and plug it and says this is exactly the juice that you need because it's exactly where you're deficient or what you need to avoid.

Lionel Ohayon: 00:48:08 I think as we start to see more and more of this focusing back on ourselves, it's going to release us from this idea of this world where everything's wrapped in plastic and we're 10 feet away from each other which would be a pretty bleak future for all of us.

Tom Jung: 00:48:26 Yeah, I could see that. I think this has obviously been such a great discussion. I'd like to see maybe if we have some questions from the audience for you guys that we can discuss and I do have one from someone that asked about long-term care facilities and the safety and isolation issue and the mental toll that isolation takes on that fragile population. Does anyone have thoughts as to what nursing homes will have to do going forward?

Dana Barr: 00:49:04 I'll take this question just simply because I've just recently lived it. My mother was in a long-term memory care facility and I didn't get to see her for two months before she passed away on May 28. I think I saw the decline in talking with her just on the phone or trying to have somebody help me FaceTime with her. I saw the decline in her well-being because she was isolated and she didn't understand why we weren't there. I think that really did contribute to the factors that ultimately caused her death.

Dana Barr: 00:49:38 At some point in time, I think we're going to have to find a balance and this goes back to something that Lionel was saying just a bit ago. We're not going to continue to have Plexiglas between us and everybody we interact with on a daily basis. I think we have to decide which of these behaviors and activities that we've adopted are things that we can live with for a lifetime and we keep doing those, and then we practice the others when they're necessary if there's something like a disease outbreak occurs.

Dana Barr: 00:50:09 I think that there has to be some solution where people in long-term facilities can see their loved ones because I think mental health is just as important at their age as is their physical health. Their quality of life diminishes if they can't see the ones they love. I think that's something that really has to be dealt with. I know in my mother's home that they had people that would be outside the window and talking to their loved ones to the window, and that's great. You can see it, but again if there is some mental incapacity there, they might not understand why you're not physically there with them and that's really hard. It's hard for them. It's a struggle.

Tom Jung: 00:50:45 Yeah, I could see that. Hank, have you seen anything in your design of healthcare facilities particularly for long-term care that might respond to this issue?

Hank Adams: 00:50:58 We have done a lot of long-term care work particularly in Canada and there's actually quite a bit of investment right now going into long-term care in Ontario in particular. The authorities there are really trying to look at how to, I guess, approach future design to new standards based on the pandemic.

Hank Adams: 00:51:19 I do think that there are a lot of really hard choices that have to be made about how residents are grouped into what numbers and how outdoor space is used within their living areas. And also, just as Dana just shared, it's how you can allow them to remain connected during periods like a pandemic or when there's concern about visitation and all that. I know that there's a lot of work being done in that area that I think that have to provide a safer environment both for the workers and for the patient in there.

Hank Adams: 00:52:01 And I also think, too, that there needs to be more, I guess, if you will, alignment with healthcare providers because I do know that it those relationships are established before the crisis hits between hospitals and long-term care facilities, there's maybe a better way of helping to support infection control measures, support them with PPE. Those kinds of networks, I think, were really exposed where there were problems in the long-term care environment. Many of them had the same difficulties with supply chain that the hospitals had. I can see there being a better relationships and alignment with those organizations.

Tom Jung: 00:52:48 We have another question at first doesn't sound necessarily completely related, but when you think it through, it's totally related and it has to do with climate change. I think the overall issue is how has the public been put on notice that maybe we need to pay more attention to our built environment, and because of this concept of this pandemic, people are much more aware of the effect that a great event can have on our everyday lives and I wonder if designers will now have even more on their plates thinking about possible issues, I guess, related to climate change and the effect that could have on our built environment. Any of you have any thoughts on that?

Dana Barr: 00:53:36 I'll go ahead and speak again because this is really right in my purview of environmental health. This is something that we're very concerned about.

Dana Barr: 00:53:44 I think that one of the positive aspects of this pandemic is we have a lot of people working from home and teleworking so we have a lot less pollution in the air which also helps with climate change. A lot of people don't understand that climate change doesn't just mean global warming, but it really means this unleashed energy in the atmosphere that causes a lot of weather extremes. A lot more Category five hurricanes and F5 tornadoes and such extreme temperatures, and that can really change disease etiology.

Dana Barr: 00:54:22 For example, with vector-borne disease, it's normally in a more tropical climate. It could move further north. That really can have a profound impact on health in general. It's an important thing. But I think it's one of the positive things we've seen because of the pandemic is a reduction in air pollution in particular.

Lionel Ohayon: 00:54:42 When I think about climate change and I think about this conversation we're having about behavioral change, and back to what Dr. Barr was saying about being at home and learning that you can live at home, I just questioned how we could take that forward and can we solve for traffic? Can we solve for rush hour? Are we big enough to ask those questions because maybe through the pandemic we've learned that 9:00 to 5:00 really is a problem and it's causing climate change and we can reduce those emissions by just understanding how people decide to move about and what time they do it.

Lionel Ohayon: 00:55:24 There's big opportunity all across the board, if we want to take it.

Tom Jung: 00:55:29 Interesting. How difficult will it be to design for all of these? Let's acknowledge that. We still don't know how behaviors are going to change and how procedures might possibly change not only in a grocery store or a restaurant, but also obviously in healthcare facilities as a result of this pandemic and trying to address some of the issues that have been raised by it.

Tom Jung: 00:55:56 Can we really design now or do we have to wait until all of these changes are made so that we can design appropriately? It would be terrible to design a facility the way we think it should be designed and then have the procedures change so drastically that facility no longer works physical plant. Which comes first? The chicken or the egg? Does that put more pressure on the design industry, do you think?

Lionel Ohayon: 00:56:17 I think it's incremental. I think every project is moving the ball forward a little bit. I don't think you can stop and wait to that point. We're looking at these facilities and actually taking an inventory of how many spaces are actually clinical and how many spaces are supporting the clinical intervention. And do you need all those spaces? Could they be transformed to something different? What do you actually do better?

Lionel Ohayon: 00:56:41 You brought up the conversation about waiting. Waiting is not good. You need to be actively engaged and doing something and inspired so that your outcomes are better if it's possible and have as few touch points as possible by using technology that exist to allow certain mundane things that happen in hospitals to go away forever.

Lionel Ohayon: 00:57:03 And then even questioning, "Do I really need to go to the hospital?" We've all heard so many of the KPIs about just people having to come into a hospital, dealing with traffic, getting there, going through the system, and then realizing they really didn't need to come, they could have this conversation on the phone.

Lionel Ohayon: 00:57:20 To me, I think you have to keep pushing forward with the idea of what that hospital serves or what that facility serves for the people who are using it and continue to ask the question about what the experience will be like. That's where we come at it from so that we can investigate each part of it. It's part of the routine and the journey and then through that each single space. But I think that there's no way... We couldn't have anticipated this pandemic or this outcome. We couldn't anticipate a pandemic, but tomorrow, it's going to be something different and I don't know how to wait.

Hank Adams: 00:57:57 Yeah, I agree with Lionel. I don't think we can wait either and I think that if you think about health and wellness and healthcare delivery, it's a very complex system that spans really all aspects of our lives and our lifestyles. I think you almost have to pick the components or the elements within that system and the industry really has to step up and propose fresh and new ideas and rethink components of it.

Hank Adams: 00:58:27 Speaking of our firms, the acute care hospital in our mind is an imperative and so we have to think really carefully about the adaptability and the flexibility of our hospitals going forward. That's a term we've been using for a long time but it means something very different now. And I think that we also have to think about that flexibility and adaptability that is scalable and it is done in a way that you can continue to deliver care at a certain level, that each incremental change and risk status that they might experience. That's totally different than what's going to be happening in your community.

Hank Adams: 00:59:09 Across the entire system... I think what Lionel said, is you're going to be pushing more and more of that everyday routine healthcare and wellness to your home and to your daily life through technology and wearable devices and all sorts of different strategies.

Hank Adams: 00:59:24 Everyone on this call touches this industry and has a role and a part to play in this, I think, going forward. We have a lot of work to do. I think it needs to start out. We really can't wait to understand what the full outcome is from this pandemic.

Tom Jung: 00:59:45 We're getting towards the end of this. We've got about 10 minutes or so. But before I asked all of you about some final thoughts, I just wanted to summarize it. It's been really an incredible conversation and I was just writing down some of the high points of impact that you all foresee on our healthcare facilities going forward. Some of these are not necessarily new concepts. I'm just going to list them quickly. Some of them are not necessarily new, but I think they're things we've thought about and maybe have more visibility today and maybe we'll get a little bit more action going forward.

Tom Jung: 01:00:24 The first is innovation. We always talk about innovation. I think, Lionel, you said this, at the outset is that one of the impacts of this crisis was that we've [inaudible 01:00:38] very, very quickly in the near term. It sounds like innovation, what you've all been talking about, needs to be at the forefront. We need to be thinking about doing things differently both in the near term and going forward.

Tom Jung: 01:00:53 The other highlight is technology. I think we need to use technology differently. I heard you all say both with telehealth, how we communicate. I think actually people's attitude towards technology is probably going to change. I forget who said it, I think it might have been Dr. Barr. You talked about telemed and how previously most people when they were offered the telehealth option said, "No, I want to go see my doctor. If I have an appointment, I don't want to do it remotely."

Tom Jung: 01:01:30 This has changed all of that. Suddenly, people are saying, "I did telehealth with my doctor, and it was great, and it was awesome. And it saved me the drive and I got exactly what I would have gotten out of it if I had gone physically." I think changing people's perceptions on things particularly when it comes to technology and an increased use of technology is important.

Tom Jung: 01:01:48 But the third thing, most importantly, Lionel, all three of you have really hit upon the concept of human behavior and at some point, it'd be interesting to hear your thoughts are about what is our responsibility for behavior? Do we have a civic duty to behave in a certain way? Those are some of the things that I'm sure we'll be confronted with going forward.

Tom Jung: 01:02:14 And then the final thing that I saw listed was, and this may even be one of the most important if not basic things is Dr. Barr, you talked about increased collaboration and importance of public health with our healthcare system because one of the things we see today is the importance of testing and we can't keep up with the requirements for testing. And then, our testing system is so overwhelmed that it takes so long to get a... If it takes you four days to get the result of a test and it's negative, but you could have come down with COVID in the intervening four days.

Tom Jung: 01:02:50 We definitely need to look at our public health system and almost as important as the data if not more important. We've got to collect that data so that our healthcare professionals know how to react and they need to know what's going on with contact tracing and everything else.

Tom Jung: 01:03:05 And then obviously, that will spin off into other things where we start keeping track of obesity and blood pressure and diabetes, and people will become maybe more aware of those issues and maybe their behaviors will change, and that will become a healthier population.

Tom Jung: 01:03:20 Those are some of the issues that I saw as takeaways. I don't know if anyone... Do any of you have any more that I missed there? That seems to put it in a nutshell.

Tom Jung: 01:03:29 This has been a great discussion. Before we leave, because we're nearing the end, I just wanted to ask if any of you had any thoughts about what's next and where do we go from here?

Tom Jung: 01:03:41 Let's see. Hank smiled and so I'm just going to go to Hank. I'm going to go around the screen here in no particular order but that.

Hank Adams: 01:03:49 Yeah, thank you. In my mind, what's next is as an industry, I think I know a lot of our peer design practices around the country are all trying to work towards the same goal is to analyze and process the pandemic and try to understand what are those lessons learned, how we're going to apply them long term.

Hank Adams: 01:04:12 I think that there is a... I guess maybe to what Lionel said earlier was this idea about getting back to normal. Yes, we all do hope in the next year, year and a half, or whatever, things do return back to normal and behaviors will align with what that new normal looks like. But the fact is that this disruption is an opportunity for us to create a better normal and really almost to use the crisis to our benefit and elevate the things about our healthcare system that we just frankly don't like.

Hank Adams: 01:04:45 We've talked about waiting. Simple things like that. Really, why do we have to wait when we go into any venue for our healthcare between technology, between data, between operational practices and facilities. We can solve problems like that if we can eliminate those really annoying parts of our healthcare delivery.

Hank Adams: 01:05:08 Back to your comment about the innovation side of things is I think we have a chance to really innovate and focus on the things that will be really great. The fact is after 9/11 we still have airport security and that has stuck around. There are going to be some things like that. There'll be components from the pandemic that will be with us from here forward but if we can, at least, hold on to those [inaudible 01:05:31] things and improve our lives and make us healthier and use that as the innovation catalyst, I think, that's really what the industry is going to be looking for.

Tom Jung: 01:05:40 Dr. Barr, what do you think happens? Where do we go from here?

Dana Barr: 01:05:45 I think that we're going to see a lot more interaction between public health and clinicians that really needs to happen. I think we've seen how important it is and how it can form a lot of things. I think it's [inaudible 01:06:00] capitalize on the momentum that we've had from this pandemic to make improvements in our testing services, in the streamlining of healthcare and the offering telehealth services as well. I think it's a positive [inaudible 01:06:18] that we can make a better new normal.

Tom Jung: 01:06:25 Interesting. Lionel, where do you think we go from here? What are your final thoughts?

Lionel Ohayon: 01:06:31 You want me to be optimistic or pessimistic?

Tom Jung: 01:06:35 Honest, I want you to be honest, we want you to be honest.

Lionel Ohayon: 01:06:37 I'll tell you what. I think that there is a tremendous amount of pain and suffering right now. I'm astonished at how little is spoken about or understood... How little compassion seems to be surfacing on the fact that so many people have lost their lives [inaudible 01:06:57] we all know all that. But just the very fundamental understanding of what this country is actually going through and how woefully ill equipped it is to deal with it.

Lionel Ohayon: 01:07:08 For me, the brave new world is some... I don't even want to call it an evolution. It's like a revolution of thinking about how we care for each other and about what that means across all touch points of our lives. I think that it's naive to think that we're quickly going to move in a massive infrastructural reset in America.

Lionel Ohayon: 01:07:30 But there's a lot that we can do with behavior. There's a lot that we can do with education. There's a lot that we can implement into our lives and change this perception of what it means to be in something together, because I hope that everyone will walk out of this and go, "We really are all in this together." At a very minimum, whatever you think, if we don't all act, we all suffer kind of thing.

Lionel Ohayon: 01:07:52 To me, I think it's a question of taking that challenge as a nation and as a group of professionals and using our access to the parts of it that we know to form alliances and create change. And yeah, I hope we have a lot of opportunity to rebuild the world that we live in. It's a great opportunity. But I really do think that it's an opportunity for us to really understand this notion of what does it mean to be part of a group and what's my responsibility in it. And we can do it. I really think that that's in some ways the short outcome that could have the biggest impact.

Tom Jung: 01:08:36 If I had to think about where do we go from here, I would build on what all of you has just said and I'm going to steal something, Lionel, that you made me think when you said in a previous discussion. You said after 9/11 everyone said I'm not going to get on a plane again and we're not going to build tall buildings again. And we're flying more than ever, at least, before this pandemic and we're building taller than ever. It's not that people forgot. But I think the further away you get from the fear and the situation, the less it governs your behavior.

Tom Jung: 01:09:11 I spent 30 years primarily in the regulatory arena for healthcare, and I have to admit, New York State has a very regulated healthcare system, certificate of need process, and I was one of those people who had to meet with facilities and say, "Yes, you'd like to build 200 new beds and you'd like to build 20 new ORs but we have to look at the finances. We have to look at the need. We have to look at what public health issues are being addressed in your community because if we address them, then you would need all those ORs. You would need all those beds." That was a tough discussion to have.

Tom Jung: 01:09:47 I can honestly say I've dealt with so many architects, designers, construction people, and hospital and nursing home people that I know they all want to do the right thing for the most part, and architects always are looking to the future.

Tom Jung: 01:10:02 I think we're all having these discussions. We're all thinking about what this means not just for healthcare, obviously, we talked about other settings, including education and commercial and whatnot. But I think I hear you, Lionel, that this sense of urgency may fade and Dr. Barr, you said we have the momentum now and we should take it. I think maybe what I take away from all this and from hearing you all speak is that maybe the responsibility is on us and it's on everyone that's tuned in to these webinars over the last three sessions to say...

Tom Jung: 01:10:35 Because if something happens in 10 years and we're not ready, they're all going to point at us and say, "You saw what happened in 2020. Why didn't you prepare?" And maybe we'll take that as a rallying call and maybe this will make our job easier to think out of the box so that hospitals and other types of settings can be more flexible and more adaptable and more technological and more able to respond to unforeseen urgencies like this.

Tom Jung: 01:11:06 I guess I take it as a rallying call and hopefully, everyone on this call and you all take that in the right vein and you're encouraged by it and hopefully, clients are encouraged by it, and that's exactly what we do is we continue to work even as the urgency abates. Thank God. Hopefully, it will abate eventually. But I think we need to keep this at our forefront.

Tom Jung: 01:11:26 We talked about climate change and we talked about this pandemic and conceivably, there will be obviously other emergencies that we'll have to deal with to the extent that we can deal with it. I think I'm just surprised how unprepared we are in all aspects of life, not just healthcare, obviously, but in our day to day. We just weren't ready for it and I think we need to help people prepare. Does that make any sense?

Lionel Ohayon: 01:11:58 Absolutely.

Hank Adams: 01:11:58 It does. Absolutely.

Tom Jung: 01:11:58 Any last thoughts? I think you're all talked out. I want to send another very special thank you to our series sponsor Patcraft. Thank you so much for making these dialogues possible. Each of these sessions were recorded and they will be available on The Center for Health Design website.

Tom Jung: 01:12:26 I'd like to thank everyone who's tuned in and particularly our panel for a great conversation we had today. Thanks to all of you. This concludes this series and our challenges remain. We, at the center, anticipate hosting additional events such as these as we apply the innovative thinking to future design. Again, thank you to our panel. Thank you to everyone who signed in today and please take care everybody. Stay well and stay safe.

COVID-19: 2020 and Beyond — Applying Lessons Learned to Next Generation Healthcare