11 During my three years as a business consultant, not only did I gain a tremendous amount of knowledge and experience, I also enjoyed working in an international setting. I felt, most importantly, valued as an employee, which I never felt as an architect before. This was a new world where the term architecture was not limited to the context of the built environment, but was being used in entirely new contexts, such as business architecture, IT architecture, and organization architecture. Viewed from this perspective, architects ought to understand the operational, organizational, and financial aspects of building projects, so that they could participate in decisionmaking. What led you into the field of project management after that? I was approached by a former colleague to join a project management firm to help develop new hospital building concepts. Quite honestly, I had doubts in the beginning about joining this firm. As much as I liked the idea of getting back to working on the built environment, I was worried that architecture would not be a primary focus, for either the project management firm or for hospitals themselves. However, I was intrigued by the possibility to work on large-scale building projects. I eventually joined the firm under the condition that we would involve not just project managers and hospital specialists, but also architects in the process. The first client project we did was for a hospital in Delft. I was fascinated by the complexity of the project. I needed to grasp not just the large scale of hospital buildings, but also aspects such as the operational processes, finance, and the perspectives of the various stakeholders such as patients, medical specialists and hospital employees. In order to further develop my skills, I enrolled for a Masters programme in real estate in 2003 at the University of Amsterdam. This study provided some of the initial ingredients that I developed further in my PhD research. Your PhD research is about the added value of architecture in hospital care. You seem to have touched upon a wide range of issues: architecture, business, health care, and hospital management. What are the correlations between them in your research?
handed over by clients. This is why when a crisis hits, architects lose their ground. So what I’m trying to redeem is a strategic and central role of architects. In the field of health care for instance, hospital buildings are expected to function for twenty to forty years, while medical processes, techniques, and devices evolve every three to five years. Making a good design brief with such a long planning horizon is a major challenge. Hospital employees often end up falling back on the old ways of working. If architects can play a more proactive consulting and strategic role, then their architectural vision becomes more than a mere visualization of their commission. It helps develop the strategic vision of the hospital organization. By contributing in this manner at the programme management levels, as opposed to just being a participant at the project level, architecture creates added value. Do you find architects too arrogant to step out of the designer’s role and delve into business management? No, I think they are naïve instead. I was once myself when I designed a villa as a student. I was unaware of the complex reality of restrictions, finance and other aspects. Soon I realized that getting the next villa is not easy at all.
“I REALIZED THAT THE ONLY WAY TO REALLY BECOME AN ARCHITECT WAS TO GET AWAY FROM IT.”
One example that helps explain this is the renovation of a number of outpatient departments at a hospital, where I used the opportunity provided by the renovation to introduce a new way of working. We set up a series of workshops with doctors and hospital employees to identify and prioritize the objectives and key value drivers for the renovation. The primary focus was on improving business processes of the outpatient department and making these more patient-centric, rather than on managing and executing the process of building renovation. One of the changes we requested was to appoint the medical manager, instead of the facilities manager, to lead the renovation project. The reason was that the key value drivers of the renovation are not just better facilities and medical devices, but are related to the quality, safety, efficiency, and user friendliness of the core medical processes. This is something I investigated in depth in my PhD research, where I relate quality of healthcare to the quality of hospital architecture at three levels: the future value, the cultural value and the utility value. The realization of these value drivers needs integration of various aspects at the strategic, managerial, operational, financial and architectural levels in the decision making process. To what extent do you think architects should be involved in this complex process? I don’t think architects should take on the sole responsibility to get this to work, but too often, architects just blindly follow the design brief
In some way, I am also afraid that we have made the architectural world too romantic in our education. Perhaps we need to rethink who we want to select and train, and what we want to tell them. Are there future plans for your research or your practice?
Not too concretely, but I certainly would continue with architecture. In the near future, I might participate in a research project focusing on the role of information technology in building designs. As for our practice, we are now a small strategic firm advising hospitals and other health providers. We have a good mix of architects, researchers and consultants. In the future, we might consider joining architecture competitions, or collaborating with an architecture firm. At the moment, there are many options.
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Colette Niemeijer Dr Colette Niemeijer is founder and owner of CEAN Consulting. The company provides advice on innovations in healthcare through the added value of architecture. She defended her dissertation 'De toegevoegde waarde van architectuur voor de zorg in ziekenhuizen' (The Added Value of Architecture in Hospital Care) on the10th of December.