In the early 2000s, much of the world recognized that biomedical research was not being applied to solving health problems like it should be. The U.S., U.K., and Canada, in particular, began initiatives to “translate” research into better clinical outcomes. This process of translational medicine consists of identifying a new approach or therapy that addresses a health need, developing and validating it, and then applying it to patient care. Facilities play an important role in supporting the necessary knowledge exchange between clinicians and researchers via collaborative work environments, improving the movement of research into clinical application to improve patient outcomes.
While this collaboration is important, most academic medical centers (and non-academic, for that matter) still primarily contain silos of knowledge. For example, clinical, research, and educational facilities sort and separate experts in the biomedical community. The challenge when a provider sets out to create a translational medicine environment, in particular, is to find ways to influence the transfer of knowledge and the sparking of ideas between these silos.
This effort becomes even more complex when you look at all of the ways collaboration should take place. First, collaboration in the workplace is crucial to better coordinate and share knowledge in care or research activities, whether it’s among clinical, research, or integrated teams. Second, research has shown that for collaboration among teams, disciplines, and professions, both importing new knowledge from outside the team as well as exporting knowledge to others outside the organization are significant factors in achieving innovation. Lastly, studies on scientific creativity show that a large percentage of creative ideas come from “combinatorial chance,” those day-to-day accidental collisions that lead to conversation and new ideas.
The physical environment can have either a significant positive or negative impact on all of these types of collaboration. Following are issues to consider when approaching a translational medicine project.
Roadblocks to collaboration
We have created a world where it’s challenging to collaborate. Our organizations separate us into institutions, corporations, disciplines, departments, and even divisions. Our facilities separate us into buildings, floors, suites, and rooms with security access at every point. This creation of territory tells us we are not wanted unless we’ve been granted “access.” At the same time, the increasing complexity of knowledge is pushing us to share more.
In the research setting, it’s relatively easy to encourage collaboration; fewer time constraints allow more opportunities for discussions within and between teams. However, we typically create collaboration spaces per floor, resulting in new types of silos. Conversely, in the clinical world, efficiency measures and patient workloads make it difficult for even routine activities like having a cup of coffee or regular lunch time, let alone time to collaborate. Clinical care personnel also aren’t as comfortable pausing to join a conversation, fearing that a supervisor might not approve or efficiency ratings might suffer.
In a translational setting, collaboration must first be embraced and encouraged at an organizational level. Then, it’s important that spaces be provided that easily allow collaboration to be part of daily activities, within and between research and clinical teams as well as other care team partners such as medical students and scientists.
To create an environment where collaboration naturally occurs, you must first recognize that collaboration occurs at multiple scales. The workplace scale, such as an office, clinical environment, or research lab, can improve the effectiveness of individuals in teams and create opportunities for multidisciplinary teams to work together. For example, at a cancer center, experts in clinical care and research in medical oncology, surgical oncology, radiation therapies, and immunotherapies might partner on the development of a therapy for a specific subset of cancer or even a specific patient.
The building scale is then critical for bringing diverse teams together to import and export new knowledge. Several key strategies, such as vertically and horizontally integrating a facility, can be implemented to increase awareness of other activities in the facility and make it easier for people to connect. For example, Johns Hopkins Research and Education Facility at All Children’s Hospital in St. Petersburg, Fla., is designed to maximize integration between research and clinical teams by connecting research laboratories and clinical workplaces through a series of open, cascading spaces that bring occupants together in multiple ways at different times. Although the building has an auditorium for campus use, this series of spaces offers multiple opportunities for “open forum” discussions that aren’t behind closed doors.
At the Shirley Ryan AbilityLab, a rehabilitation care and research facility in Chicago, creative collisions between clinicians, scientists, engineers, students, and patients occur within each of the building’s five AbilityLabs, which contain primary workplace, research, and therapy spaces. These teams share space within the labs, which has significantly increased communications and sparked numerous new ideas, therapies, and research projects.
Collaboration at the campus scale is also important for organizations where clinicians, researchers, and students are sorted into separate buildings. At Dartmouth-Hitchcock Medical Center in Lebanon, N.H., a three-level concourse connects the clinical world on the northern end with the research and education world to the south. The Williamson Translational Research Building was then plugged into the concourse, bringing public, office, and collaborative spaces to two levels. The building opens onto the concourse levels, creating a front porch, similar to inviting entries into stores in a mall. Additionally, the Williamson building created a translational network by linking to the collaborative spaces in the other buildings with a series of bridges that cross the concourse.
The “Pike” at Brigham and Women’s Hospital in Boston is an internal, single path that was developed over time and extends throughout the complex campus. It has an onstage public path on the upper level with coffee shops and other destinations where significant collaboration occurs as well as a more private offstage lower path, which can be used for travel without interruption.
Despite obstacles, significant evidence of translational success is apparent, particularly in areas such as cancer and neurosciences that embraced the concept early. A lot has been learned about the role of the physical environment and this research must be shared and further applied. In addition, many of these findings pertain beyond the academic medical center and are becoming important components of acute and primary healthcare settings. Moving forward, the next generation of translational facilities will need to address the changes that are rapidly transforming clinical care, research, and education, to continue leading to improved outcomes resulting from the multidisciplinary collaboration now taking place.
Jon Crane, FAIA, EDAC, LEED AP, is senior vice president, director, translational health, at HDR (Atlanta). He can be reached at firstname.lastname@example.org.