John Etcher recently joined HDR | CEI as a senior clinical healthcare planner, bolstering the firm’s depth on complex hospital and healthcare facilities. John has worked on healthcare projects across Canada, including the Royal Columbian Hospital, Toronto Psychiatric Hospital, Abbotsford Hospital and Cancer Centre, and many more. We sat down with him to talk about his career and the state of healthcare planning and design today.
What drew you to healthcare planning and design?
Back in 1978, two years into my career, I was put to work on a hospital in Edmonton. The planning and illogicalness of the project appealed to me; the relationships between the equipment and the processes and how they informed the shape and the design—it attracted me. I’m a puzzle person. That’s the easiest way to say it.
What changes have taken place in healthcare planning over the past 30 years?
It comes down to technology and processes. For instance, consider infection control. Healthcare professionals have to wash their hands frequently now, which makes sense, but it does slow the process down. When a nurse goes into patient room they wash their hands, and when they walk out they wash their hands again. 34 years ago I don’t even think there was a sink in every room.
With regard to technology, think about medical records. You don’t have hardcopy charts anymore, in most cases. For a new patient, it’s an electronic chart, so it’s on a tablet. The process is still being worked out: How a tablet should be taken into a room and out of a room, because if you’re taking it right up to the patient, then you take it out, it’s dirty—that’s where infection control and technology are trying to bridge a gap.
What changes do you see over the next five or 10 years?
I think it’s twofold: Technology is going to increase the speed of procedures, so there will be more outpatient services. When my first child was born, 31 years ago, my wife was in the hospital for four days. Now I think it’s two days. And you used to go into a hospital to have a process done and you stayed overnight, now you go to the outpatient facility for a 20-minute operation, they watch you for half an hour, and you’re out.
How do you see the aging population impacting healthcare design?
There are going to be many older people who have to attend to their bodies and their health. The solution will involve making it so that they’re not always going to an acute-care hospital.
They should be able to visit an outpatient facility that’s like a one-stop shop. You have a general check up in a medical office, and the doctor can send you to have an X-ray, and you can go and see a specialist about your gallbladder, and there’s another specialist on level two, and another on level three—and on your way out you can stop at the drugstore. Elderly people often don’t have the means to drive around to five places, when they can just stop at one location and get everything done.
What opportunities can HDR pursue in terms of healthcare planning and design in the next few years?
There is a huge infrastructure being built, by P3 and design-build, but someone is going to need to do renovations as the facilities age. The Authorities are going to say, we’ve got a new machine, a new piece of technology, so certain areas need to be revised, and they’ll need an architect. We’ll have to be efficient, and have really good quality control.
The AIBC’s intern architect program requires 3,720 hours that they must put into 13 different categories: 120 hours on-site, 80 hours on contracts, 120 hours on schematic design, etc. The smaller renovation projects, which take anywhere from six months to a year to complete, are perfect for them. You get on these bigger P3 projects and these poor guys are stuck doing design development for two years. They’re not getting other skills. So there’s an advantage to having the smaller projects for them too.
What is one of the most important lessons you’ve learned in your career?
I think my involvement with users has taught me that it’s about listening, but also asking questions. I’m always learning. I’m 64 years old, and I go into a user meeting and we are talking about something that I have done two or three different ways, and then I learn that there’s a fourth way. And then I see it can work.
What has been the most interesting project you’ve worked on?
The Vancouver Island Cancer Centre and Royal Jubilee Hospital—and those were when I was not working for an architectural firm. I was working for the Authorities. My responsibility when I was working on the Cancer Centre was to make sure the architects designed it for the users. I was basically the BC Cancer Agency’s project manager. Seeing the Cancer Centre be completed and watching the patients finally moving through—it was an emotional experience.
Every hospital I’ve worked on over the years has been a good experience. Every time I walk into a facility and I see the patients moving through, and moving through nicely, it makes me think, “We did it. It worked.” It’s a rewarding feeling.