In this article, one of six in ARCHITECT's 2021 "What's Next" series on post-vaccine architecture, contributor Gideon Fink Shapiro speaks with Roderic Walton, AIA, a Chicago-based associate principal at Moody Nolan, on how architects can improve health care access and potentially outcomes for underserved communities. With 23 years of experience, Walton has worked on significant health care projects throughout Chicago's communities of color in addition to publishing thought pieces on equity in health care, including "Healthcare in Black America—'Where We Are': The Current State of Healthcare in America."

I understand you focus on improving equity in health care design.
Walton: Moody Nolan designs a considerable number of projects for health care institutions and universities. Most of our Chicago-based health care projects are for communities of color in underserved parts of the city, on the South Side. Our core focus has been on overcoming disparity in health care.

How has the pandemic informed your vision for health care architecture and planning, now and post-vaccine?
The pandemic has exposed significant disparities in health care and health outcomes, which are often driven by social determinants of health. We often use data to analyze a person’s social determinants and predict what level of health care service they will receive and what their outcome will be. Data from sources such as the COVID Tracking Project show that Black Americans are dying from COVID at 1.5 times the rate of white Americans [at the time of publication]. When a person has two “comorbidities,” or coexisting conditions such as obesity and heart disease, they are more vulnerable to COVID. Vaccines will help curb the pandemic, but they’re not going to resolve the underlying socioeconomic factors that are driving those disparities.

Source: University of Wisconsin Population Health Institute
Source: The COVID Tracking Project by The Atlantic Monthly Group

What reforms could help level those disparities?
One thing architects can do is prioritize preventative health care and health care education. We can work with our clients and partners to build those solutions into our programming process in order to advocate for patients who need those services. One way to think of it is that the community is the health care system. If you have housing that’s not equitable, or if you live in a food desert, or if you don’t have access to preventive care, your community health system is broken. So, we have to invest in all of those services.

East elevation, Friend Health Center in Chicago, designed by Moody Nolan
courtesy Moody Nolan East elevation, Friend Health Center in Chicago, designed by Moody Nolan

How do your projects include broader notions of community health?
For a community-based health care center in the heart of Chicago’s South Side, we are building on a population health model and integrating a healthy food-service offering into the facility and expanding the patient experience beyond their doctor’s appointment or visit. Nearby is the Mile Square Health Center, an extension of the University of Illinois Hospital system. Early in the design process, I realized that the facility had to be near public transportation. We also discussed outreach strategies to make sure that the infrastructure was in place to assist with the scheduling of appointments and follow-up appointments.

Most importantly, our design meetings were focused not just on the center itself, but on empowering the entire neighborhood. Community-based health care starts with having a lot of empathy and compassion rooted in an understanding of history.

That’s inspiring. How does health care architecture intersect with the history of racism?

Redlining map, Chicago (1938)
University of Chicago Map Collection Redlining map, Chicago (1938)

Housing segregation is one of the primary factors that drives social determinants of health. Because many communities of color in Chicago are geographically isolated due to redlining, we don’t have good access to care. We’re not getting regular exams—people encounter the health care system only when they feel sick. Often that’s too late. We’re missing that whole preventative-health-care apparatus.

We can look at the history of housing segregation, redlining, disinvestment, and zoning restrictions and try to program spaces to mitigate some of those disparities. That’s an important step toward increasing the level of sensitivity toward marginalized patients and the type of care that they expect and deserve.

Does your work or your impact extend beyond the walls of the facilities you design?
As health care architects, we’re in a unique position to advocate for change. We often partner with clients who are decision-makers for their institutions. If we can make a case based on research and data, clients are often responsive to our view of community health. Beyond that, many health care architects are involved with committees and organizations that can inform policy decisions and address racial disparities.

Hospitals had to quickly reconfigure to handle surging COVID-19 cases. How will you help them prepare for future challenges?
Adaptability and flexibility are paramount in health care design. Space is finite and often the services may need to perform more than one function. For example, we’ve seen hospitals install medical gas systems and data ports into columns in their lobbies so they can repurpose that space if they have a surge. Airflow systems can be reversed from negative to positive pressure to isolate different areas. When Moody Nolan designed the Adult Level 1 Emergency Department for University of Chicago Medicine, we looked at a solution to allow the ambulance bay to serve a second purpose as a decontamination facility.

Level 1 Adult Emergency and Trauma Center, University of Chicago Medical Center
Mike Crews Level 1 Adult Emergency and Trauma Center, University of Chicago Medical Center
Interior, University of Chicago Medical Center, designed by Moody Nolan
Mike Crews Interior, University of Chicago Medical Center, designed by Moody Nolan
Level 1 Adult Emergency and Trauma Center, University of Chicago Medical Center, designed by Moody Nolan
Mike Crews Level 1 Adult Emergency and Trauma Center, University of Chicago Medical Center, designed by Moody Nolan
Level 1 Adult Emergency and Trauma Center, University of Chicago Medical Center, designed by Moody Nolan
Mike Crews Level 1 Adult Emergency and Trauma Center, University of Chicago Medical Center, designed by Moody Nolan

What’s the next big idea in health care architecture and planning?
Health care equity should receive the same emphasis as safety. Collectively we need to commit to strategies that acknowledge disparities rooted in history, and our process should strive to overcome those disparities. Just as safety is a fundamental part of the health care architect’s toolkit, and just as health care systems maintain protocols to evaluate and ensure the safety of their environment, we should create robust tools to promote and measure equity over the life cycle of a project or a building. We can work with our clients and partners to make equity a priority. And together we can transform the industry.

You mentioned the importance of data. What type of sources do you use in your research and presentations?
In terms of housing and health disparities, the data and the research are right at our fingertips. I started reading authors like Richard Rothstein (The Color of Law: A Forgotten History of How Our Government Segregated America, Liveright, 2017) through the lens of the evidence-based principles that we learn through the course of our practice.

To encourage more equitable health care development, we should have more robust policies for aggregating data about race and disparity and for using that data to incentivize developers and institutions to go into communities of color and construct health care projects, like the ones we're working on in Chicago’s South Side. This requires partnership with state and local agencies to provide financial incentives.

What kind of data do you rely on to learn about patients’ needs and experiences?
One helpful resource is the community health needs assessment, a report that every institution that receives Medicare or Medicaid funding must complete every three years. Typically it includes survey data from patients and providers. It’s enlightening to hear the patients themselves define their barriers to care. A lot of them will talk about lack of transparency in the system, not knowing how much a particular service is going to cost before they're committed to paying for it, not having enough outreach support to understand when they have to come back for follow-up appointments, or not knowing the process for getting legal advice. Health care architects can take that data and design a programming solution that specifically addresses problems identified by the clients and patients.

University of Chicago Medicine Community Health Needs Assessment 2018-2019

How do you think the patient experience could be improved?
More and more, patients are going to expect that their needs and experiences be monitored, evaluated, and improved. We need to position architectural discourse and programming to fulfill a patient-centered model of care that reaches outside the care facility. One example is expanding access to telemedicine and telehealth. Patients can begin their engagement from home. These technologies will continue to evolve and I hope they will continue to be supported at the federal level through reimbursements. For people of color, we need to think about equitable access to technology and learning how to use the technology.

How should architects engage in conversations about the lack of equity?
A substantive and sincere dialogue about racial and social disparity in architecture generally—and in health care architecture specifically—is long overdue. Health care architects can learn from this pandemic. To advance our craft and promote greater equity, we need to acknowledge the history of racism and the disparities that we're seeing today.

I’m a co-chair of the AIA Chicago Healthcare Knowledge Community. Last October, we held a panel discussion about disparities in health care, in partnership with medical facility planners and community advocates. The discussion highlighted not just housing, but also language barriers. We are trying to better understand the patient experience and wrap those discussions in a population health model that goes beyond any single building.

Are you shifting any business models or operations in preparation for a potential post-vaccine building boom in the health care sector?
We’re trying to figure this out. For now, we’re trying to learn and share as much information as we can about what the permanent implications of COVID-19 are going to be, both in terms of future design standards and from a policy perspective.

Our clients turn to us as trusted advisers. They expect us to be able to share information that will help them make the best business case for their future and position their providers, staff, and patients to respond to the next pandemic. In order to do that, we have to be armed with as much information as we can to continue to study, learn, and be prepared to adapt.

This interview has been edited and condensed for clarity.