University of Michigan Medical Center. Image courtesy of the University of Michigan.

Fellowships offer individuals the opportunity to dive into specialized areas of practice where topics and ideas can be explored and fostered within the context of the university setting. Like most architectural fellowships, many fellowships engage in work that oscillates between teaching, theory, pedagogical questioning, research, and design prototyping. However the University of Michigan offers a unique fellowship opportunity that submerses a fellow into medicine and healthcare design.

Through a partnership between the University of Michigan's Department of Surgery and the Taubman College of Architecture and Urban Planning, a Health and Design Fellowship works to encourage, as program director Andrew M. Ibrahim MD, MSc. explains, a "merging of networks [...] to create an opportunity for individuals to have a foot in both doors - architecture and healthcare." Architecture and planning haven't done a good job interfacing with healthcare and healthcare policy. However, alongside our team of students, faculty, and collaborators, I hope that we can bridge this gap." 

Dr. Ibrahim is a House Staff Surgeon at the University of Michigan, a faculty member of Taubman College of Architecture and Planning, and the Chief Medical Officer and Senior Principal at HOK. Through his years of research and leadership within healthcare, architecture, and policy, Ibrahim has worked to bridge the gaps between these areas of expertise. Archinect chats with Ibrahim to discuss the necessary shifts architecture must make to further investigate and prioritize healthcare design education and its application within practice.

Excerpt from the University of Michigan Health & Design Fellowship website:

Realizing the vision of Health in All Design will require a new hybrid workforce that can fluidly move across domains of design, research and healthcare [...] The Health & Design Fellow will train within the National Clinician Scholars Program at the University of Michigan. During the two-year fellowship based in Ann Arbor, Michigan, the fellow will acquire and hone a robust set of skills in qualitative and quantitative clinical research methods, organizational & social change, program development & evaluation, team management, implementation science, innovation, and policy analysis.

What motivated your interests in architecture and medicine?

Growing up, I was torn between becoming a doctor and becoming an architect. I completed my undergrad and received my medical degree from Case Western Reserve University. I also did foundation course work at University College London and The Bartlett School of Architecture during that time. 

When I finished my time at The Bartlett, I started medical school and was curious to know who were the architects and planners that work within the realms of healthcare and design. When I asked around the medical school, many people kind of laughed and said: "They don’t work here." I was quite surprised. “Who then was thinking about access to care and regional planning models?” I thought. This lack of hybridization of the two professions bothered me, so I decided to reach out to all the firms that worked within healthcare design. I wanted to figure out "who were the clinicians in those firms so they could serve as mentors for me." 

I began to wonder, "How is this possible? How are they working on billion-dollar projects with no one on their team who understands day-to-day healthcare delivery, policy, and management?"

Which firms did you reach out to and what did you discover?

I reached out to all major global firms and I was shocked to learn that almost none of them had a full-time doctor or clinician as part of their design team. Some had part-time consultants, but it wasn't necessarily a priority commitment. I began to wonder, "How is this possible? How are they working on billion-dollar projects with no one on their team who understands day-to-day healthcare delivery, policy, and management?"

It seems as though your passion for this topic emerged from its lack of focus in both fields?

Yes. I was frustrated a bit with what I was discovering. A turning point, however, was being appointed to the AIA Design and Health Leadership Group. It consisted of about 20 people across the fields of architecture, planning, policy and medicine who were passionate about health. Together,  we wanted to leverage our collective expertise to emphasize the relationship between health and the built environment. We drafted papers and conducted research to show how the built environment affects health daily. We wanted to explore the tangible ways the built environment could have a positive impact on health. I was motivated that the AIA was so engaged and that firms realized it was also becoming more important to clients. 

Through your own experiences, it's apparent that understanding healthcare delivery, policy, and design practices is missing in the industry. 

I believe that architects could really benefit from added expertise in public health and healthcare delivery. We need to systematically develop ways in which we can incorporate health in design and then find strategies to measure and evaluate these outcomes after the building is in use. After experiencing this during my academic and professional journey into architecture and medicine, I realized most of these decisions really happen in practice and to understand it, I needed to join a firm. 

We need to systematically develop ways in which we can incorporate health in design and then find strategies to measure and evaluate these outcomes after the building is in use. After experiencing this during my academic and professional journey into architecture and medicine, I realized most of these decisions really happen in practice and to understand it, I needed to join a firm. 

Can you talk about how you started working at HOK? How does one become a Chief Medical Officer and Senior Principal at a top architecture firm? 

I joined HOK three years ago as their first Chief Medical Officer; we essentially created that position. When I presented my findings and explained the importance of a role like this within firms, HOK believed in it. They understood that architectural practice could benefit from many of the methods and frameworks used in medicine, such as measurement and quality improvement. After working with them, I was able to develop a better understanding of what the "pressure points” are when firms don't want to adopt health recommendations or why a client isn't going to buy-in. 

How has your work now impacted the development of this fellowship at the University of Michigan?

Currently, I split my time between HOK and the University of Michigan. I move back and forth between the day-to-day realities of being a front-line provider then to a large firm taking on enormous design challenges that impact health. Two years into this new role, I have been able to identify knowledge gaps and opportunities for both sides to improve. My experiences propelled me to think, “Why not give more people that experience of living in both worlds? Why not train architects about the methods used to understand and evaluate healthcare delivery so they can bring that back to practice and share this knowledge with firms and clients?"

How long has the fellowship been going on? 

The University of Michigan has a long history of training early career physicians in the advanced analytics of healthcare delivery. Most recently, it's been through their National Clinician Scholars Program.  Collectively there are about 20 people in the group coming from medicine, nursing, pharmacy and social work. This will be the first year we broaden it even further to include an architect or urban planner. I want this fellow to be taken out of architecture and surrounded by other healthcare, public health and policy professionals so they can broaden their network and level of expertise to take back to practice.

What will this fellow gain from the program?

This fellow will be armed with a broad set of skills, but most importantly, new tools and methods revolving around healthcare delivery, policy, and management. A high focus will be placed on quantitative methods, so called “big data” analytics. It’s a skill that I think is present in very few firms, but could be very valuable.

Who would be your ideal candidate for this fellowship?

In my mind, it would be someone who has already worked in the industry for at least two to three years. My ideal candidate is someone who understands the landscape of the profession and recognizes these "gaps of knowledge" between health and design. This fellow will keep some ties to professional practice, maybe about one half-day a week.  The candidate will spend the majority of their time working in the cohort, building new networks and acquiring new skills. 

Ideally, I'd love to have someone who can help explore and create a strategic plan to better leverage the built environment for health. This may mean hospitals and telehealth, but it may also mean city planning, office buildings, hotels, and stadiums. I'd love to work with a fellow who can help explore opportunities for repurposing buildings that could be reimagined as ways to improve health for the people who engage in it.

I think the way we're doing it here is the first of its kind. There are other programs out there that have a healthcare focus, but those are a bit different because the core of its training is still architecture based. This fellowship has a different foundation altogether.

We're taking individuals away from architecture practice and immersing them into healthcare, healthcare policy, econometrics, ethics, law, etc. to make broad sweeping changes to healthcare delivery.

Our office chats with many architecture programs, and this particular fellowship seem to be the only one of its kind?

We initially came up with the idea to introduce an architecture candidate into the fellowship back in December. I shared the idea with the department, and we got a lot of positive feedback. After that, the planning stage took two to three months to get things in motion, and now we're here with our first opportunity to extend this fellowship to the architectural community. 

I think the way we're doing it here is the first of its kind. There are other programs out there that have a healthcare focus, but those are a bit different because the core of its training is still architecture based. This fellowship has a different foundation altogether. We're taking individuals away from architecture practice and immersing them into healthcare, healthcare policy, econometrics, ethics, law, etc. to make broad sweeping changes to healthcare delivery. They'll have architecture mentors available, but the core faculty teaching them will be from the medicine and public health profession. 

The great thing about working with Dean Massey and the faculty at Taubman is their emphasis on being interdisciplinary and broad [...] having some faculty deep in theory, but also others (like myself) who are deep in practice and can reflect the day to day challenges that architecture practice is facing right now.

What's the response been like from the architecture department at Michigan? 

The great thing about working with Dean Jonathan Massey and the faculty at Taubman is their emphasis on being interdisciplinary and broad. That includes having some faculty deep in theory, but also others (like myself) who are deep in practice and can reflect the day-to-day challenges that architecture practice is facing right now. He's been really visionary in creating a complementary blend of both that thrive and support each other. 

The department's exploration and leadership in this has paved a path and opened the door for a type of disciplinary crossover. I remember Dean Massey explaining to me that whatever people need to know to practice architecture and planning, he wanted that reflected at Taubman. For him, if HOK hired a physician to make health a priority in design then Taubman could have a faculty member who's also a practicing physician. 

What do you hope this fellowship creates? 

I hope this fellowship creates an opportunity for individuals to have a foot in both doors - architecture and health. Architecture and planning recently have gained more momentum toward integrating health and public policy, but there are still very real knowledge and practice gaps. However, alongside our team of students, faculty, and collaborators, I hope that we can bridge these gaps quickly. This year we'll start with one fellow, and we aim to scale up and increase our fellowship size as years progress. 

With the application deadline due on April 1st, what do you suggest for individuals who are interested but may not have the opportunity to apply this round?

Please do reach out to me directly. Independent of the fellowship, we can find ways to connect and collaborate. We also plan to open the process again next winter.