The Architecture of Healing – Détails, épisodes et analyse

Show Notes – Michelle Mader

In this episode of The Architecture of Healing, host Chase Miller sits down with Michelle Mader Managing Director of Healthcare Strategic Advisory Services at Ankura, to explore the complexities of healthcare strategy, capital deployment, and the balance between mission and margin in today's healthcare landscape.

Michelle brings deep expertise in helping large health systems prioritize capital deployment—essentially deciding where, when, and how to invest limited resources. From mission-driven nonprofits to shareholder-focused for-profits, she explains how healthcare organizations are navigating unprecedented challenges, including tightening budgets, aging populations, and shifting state and federal regulations.

Michelle leaves us with a big idea: true transformation requires aligning financial incentives with patient access and outcomes—a shift every U.S. administration has wrestled with for decades.

She provides a fascinating historical lens, tracing healthcare's evolution from employer-sponsored benefits in the 1940s through Medicare/Medicaid in the 1960s, the access-focused era of the 70s–90s, and today's cost-control environment.

Whether you're a healthcare leader, strategist, designer, or simply curious about the forces shaping our healthcare system, this episode offers practical insights and big-picture perspective on how organizations can adapt, prioritize, and innovate in the face of rapid change.

What You'll Learn in This Episode

• Capital Strategy & Prioritization – how healthcare systems balance limited resources with seemingly unlimited demands.
• The balancing act of healthcare as both business and humanity — why financial viability is essential for mission-driven care.
• Legislation and state-level impacts — how policies in Indiana, Maryland, and beyond are reshaping reimbursement and provider strategy.
• Rising Costs & Aging Populations – why healthcare in the U.S. faces such persistent financial strain.
• Generational eras of U.S. healthcare — from post-WWII infrastructure expansion to today's cost-control era.
• Operational trends in cost management — standardization, service consolidation, and smarter use of fixed assets.
• Mergers & Acquisitions – how consolidation drives standardization but doesn't always lower patient costs.
• Technology's promise (and pitfalls) — why healthcare IT hasn't yet delivered cost savings, and how cybersecurity and financial reform must catch up.
• The Future of Healthcare Delivery – how shifting demographics, financial reform, technology, and new care models will shape where and how people access care.

About Michelle Mader

For over 24 years, Michelle Mader has been at the forefront of transforming healthcare organizations through comprehensive system-based strategic initiatives. Her expertise lies in planning for national, multi-state, and regional networks. Michelle crafts strategic and capital plans by analyzing and collating market, financial, regulatory, operational, and facility opportunities. By prioritizing financial viability and identifying positive investment indicators, she streamlines the development process for clients, accelerates funding approvals, and fast-tracks implementation.

Resources

How to Connect

Connect with Michelle

Connect with Chase

www.thearchitectureofhealing.com

The views expressed herein are those of the podcast guest and not necessarily the views of Ankura Consulting Group, LLC., its management, its subsidiaries, its affiliates, or its other professionals. Ankura is not a law firm and cannot provide legal advice. 

Show Notes

In this powerful conversation, host Chase Miller sits down with designer and gerontologist Pattie Moore, a pioneer whose groundbreaking work forever changed how we think about aging, design, and accessibility. Pattie shares the remarkable story of disguising herself as an 85-year-old woman in the late 1970s to experience firsthand the challenges elders face in the built environment. Her courageous research journey across more than 100 cities not only influenced design thinking but also contributed to shaping the principles behind the Americans with Disabilities Act (ADA).

From her early days navigating skepticism at Columbia University to shaping global conversations on universal design, Pattie opens up about blending creativity with social science, the mentors who inspired her, and the lessons she continues to pass on to a new generation of designers. This is an unforgettable episode about empathy, resilience, and the power of design to transform lives.

What You'll Learn in This Episode

• How Pattie combined design and gerontology to create a new human-centered design discipline
• The origin story of her groundbreaking elder-disguise research project
• Firsthand experiences of how society treated elders before the ADA
• Why ADA compliance is just the starting point—not the finish line—for inclusive design
• The role of empathy, storytelling, and lived experience in shaping better environments
• Pattie's insights into teaching, mentoring, and inspiring the next generation of designers

About Pattie Moore

Pattie Moore is an internationally recognized industrial designer, gerontologist, and social innovator. Known for her pioneering research on aging, she has dedicated her career to advancing inclusive design—creating products, environments, and systems that work for people of all ages and abilities. Her work has influenced policy, product development, and architectural standards worldwide.  She continues to teach, mentor, and speak worldwide on the intersection of design, aging, and health.

Resources

Pattie Moore's Book: Disguised: A True Story

Disguised

How to Connect

Connect with Pattie

Wired Article

Medium Article

Connect with Chase

www.thearchitectureofhealing.com

In this episode of The Architecture of Healing, host Chase Miller sits down with Corey Gaarde, Principal at IMEG, to discuss how thoughtful integration of technology can profoundly impact healthcare design and delivery. Corey shares how his early fascination with science and engineering eventually led him to a career in healthcare technology. Together, they explore how the physical environment and care delivery models must be aligned with evolving clinical technologies, from supporting virtual nursing to reducing alarm fatigue and enhancing code response. Corey emphasizes that technology isn't just about devices and data; it's about supporting clinicians, improving patient safety, and enabling scalable, future-ready care models. This episode is a must-listen for healthcare executives, designers, and planners looking to reframe technology as a foundational element in healing.

Topics

• Technology Must Be Integrated, not an afterthought
• Patient and Staff Experience Go Hand in Hand
• The Unlimited Potential of Virtual Care:
• Training and Change Management Are Essential
• Design for Scalability, Not Just Day-One Use

Resources

Born to Run

Built to Last

How to Connect

Connect with Corey

Connect with Chase

www.thearchitectureofhealing.com

The Architecture of Healing explores how healthcare strategy, design, and clinical experience come together to shape the future of care. Hosted by Chase Miller, this podcast is for leaders and thinkers designing a more human, strategic, and healing healthcare system.

In this episode of The Architecture of Healing, host Chase Miller sits down with Scott Reitano, founder of Reitano Design Group, to explore the often-overlooked world of healthcare food service design.

From patient meals to retail dining and staff amenities, Scott shares how food service is evolving into a critical component of patient outcomes, staff satisfaction, and overall healthcare experience. The conversation dives into the concept of "food as medicine," the role of design in influencing healthier choices, and how hospitals can rethink food service as both a strategic asset and a human-centered experience.

This episode challenges traditional thinking and highlights how nutrition, environment, and thoughtful design intersect to shape the future of healthcare.

 Key Takeaways

• Food service is more than a necessity, it's a strategic driver of patient experience, staff retention, and brand identity.
• Healthcare dining has multiple audiences: patients, staff, and visitors, all with different needs and expectations.
• "Food as medicine" is gaining traction, integrating nutrition directly into care plans and recovery strategies.
• Design influences behavior: layout, presentation, and accessibility can nudge healthier food choices.
• Distributed dining and food accessibility are critical in large facilities to improve convenience and experience.
• Technology (mobile ordering, robotics, smart systems) is reshaping how food is delivered, but should enhance, not replace, human interaction.
• Flexibility in design is essential to adapt to changing food trends, labor challenges, and future innovations.
• Food service can extend beyond the hospital stay, supporting patient recovery and long-term health habits at home.

Why This Matters

Healthcare systems are at a turning point. Food is no longer just about feeding patients, it's about improving outcomes, reducing readmissions, and enhancing quality of life.

By rethinking food service as part of the care journey, organizations can:

• Improve patient recovery and satisfaction
• Strengthen staff recruitment and retention
• Build stronger community connections
• Reinforce their brand as a true "health system"

This shift from reactive care to proactive wellness where nutrition plays a central role, could redefine how healthcare is delivered in the years ahead.

Resources Mentioned

• Good to Great by Jim Collins  - https://www.amazon.com/Good-Great-Some-Companies-Others/dp/0066620996

About the Guest

Scott Reitano is the founder and owner of Reitano Design Group, a firm specializing in food service design across healthcare, education, and other institutional environments. With over 20 years of experience, Scott focuses on creating spaces that enhance operations, elevate user experience, and connect food with wellness and community.

https://www.linkedin.com/in/scott-reitano-22a1768/

https://www.reitanodesigngroup.com/

About the Podcast

The Architecture of Healing explores how the built environment shapes health, wellness, and human experience. Through conversations with industry leaders, the podcast uncovers insights at the intersection of design, healthcare, and innovation.

Learn more: https://www.thearchitecturofhealing.com/
Connect with Chase Miller: https://www.linkedin.com/in/chase-h-miller/

In this episode of The Architecture of Healing, Chase Miller sits down with healthcare planning pioneer Cynthia Hayward to explore how data-driven planning, operational strategy, and flexible design shape the future of healthcare environments. With over 40 years of experience, Cynthia shares her passion for pre-design planning, the evolution of healthcare space standards, and the development of her influential SpaceMed Guide.

From avoiding costly overbuilding to designing adaptable, patient-centered facilities, this conversation dives deep into the intersection of strategy, operations, and architecture, and why the best solutions often have nothing to do with design at all.

Key Takeaways

• Pre-design planning is critical: Functional space programming should be completed before design begins to avoid scope creep and inefficiencies.
• Space is driven by operations not wishlists: Effective planning requires analyzing workflows, staffing, and demand, not just user requests.
• Flexibility is essential: Multi-use spaces, shared resources, and adaptable infrastructure are key to future-ready healthcare facilities.
• Overbuilding is a major risk: Many healthcare systems invest in unnecessary space due to competition, poor forecasting, or outdated assumptions.
• Outpatient shift has mixed results: While some services thrive outside hospitals, others have created redundancy and inefficiency.
• Healthcare challenges are interconnected: Issues like ED overcrowding are often operational and systemic, not just facility problems.
• Technology continues to reshape space: Telehealth, automation, and imaging advancements are redefining how facilities are planned.

Why This Matters

Healthcare organizations are making some of the largest capital investments of any industry, yet many projects fail to align with actual operational needs.

This episode highlights a crucial mindset shift:
Better buildings don't fix broken systems.

By focusing on data, workflows, and long-term adaptability, healthcare leaders and designers can:

• Reduce unnecessary capital spending
• Improve patient and staff experiences
• Create facilities that evolve with technology and care models

Resources Mentioned

• SpaceMed Guide (Cynthia Hayward) - https://www.spacemed.com/
• Healthcare Facility Planning: Thinking Strategically (Cynthia Hayward) - https://www.ache.org/learning-center/publications/books/2307i
• Facility Guidelines Institute (FGI) Guidelines - https://fgiguidelines.org/
• The Tyranny of Merit by Michael Sandel - https://www.amazon.com/Tyranny-Merit-Whats-Become-Common/dp/0374289980
• Press Ganey Patient Experience Reports - https://www.pressganey.com/resources/blog/patient-experience-2025-new-trends/

About the Guest

Cynthia Hayward is a leading expert in healthcare facility planning and capital strategy with over four decades of experience. She is the founder of Hayward & Associates and the creator of the SpaceMed Guide, a widely used pre-design planning methodology. Cynthia has worked across the U.S. and Canada, helping healthcare organizations optimize space, reduce costs, and align facilities with evolving care delivery models.

About the Podcast

The Architecture of Healing explores how design, strategy, and innovation are transforming healthcare environments. Through conversations with industry leaders, the podcast uncovers insights that shape better outcomes for patients, providers, and communities.

Learn more: https://www.thearchitecturofhealing.com/
Connect with Chase Miller: https://www.linkedin.com/in/chase-h-miller/

What if the greatest risk in your next master plan isn't cost overruns, but strategic drift?

In this episode, we challenge the conventional approach to healthcare master planning. Instead of starting with towers, bed counts, and square footage, we begin with something more foundational: posture. Because once capital is committed at scale, you're not just building space, you're hardening assumptions about care models, workforce structures, referral flows, and financial resilience for the next 10–20 years.

Using the fictional (but very familiar) case of Riverside Health, a three-hospital system navigating tight margins, workforce strain, and accelerating outpatient growth, we walk through five structural requirements that separate facility planning from true strategic master planning.

This conversation is for healthcare executives, board members, planners, architects, and strategists making long-term capital decisions in uncertain environments.

Master planning isn't about buildings. It's about disciplined commitment under volatility.

Key Takeaways

1. Define Campus Role Before You Define Space

Every campus must have a clear, forward-looking role, what it concentrates on and what it intentionally does not do.
Balance is not strategy. Capital should sharpen differentiation, not preserve legacy politics.

2. Design for the Care Model You're Intentionally Building

Projecting current volumes forward is modeling, not direction-setting.
Stress test capital plans across multiple demand scenarios (stable, -10%, -20% inpatient). Build flexibility through convertible rooms, universal layouts, and shell space.

3. Integrate Workforce Probability Before Capital Locks In

Duplicating high-acuity services across campuses multiplies staffing risk.
Require 10-year recruitment probability modeling, attrition sensitivity analysis, and call coverage stress simulations before approving expansion.

4. Sequence Capital for Optionality, Not Momentum

Large, visible first phases may feel bold but they reduce flexibility.
Stress test phasing against revenue contraction, reimbursement compression, and construction cost escalation. Optionality is structured patience.

5. Embed Governance Architecture That Prevents Drift

Most master plans don't fail dramatically, they erode through exception accumulation.
Annual role validation, deviation thresholds, and board education are essential to prevent strategic drift, especially through leadership transition.

Why This Matters

Strategic drift is rarely intentional. It's gradual. Structural. Quiet.

It happens when capital reinforces legacy assumptions instead of clarifying future direction. And once concrete is poured, flexibility narrows.

Healthcare leaders today face:

• Volatile reimbursement environments
• Workforce instability
• Shifting site-of-care demand
• Accelerating outpatient migration
• Leadership turnover cycles

A master plan without role clarity, workforce integration, demand stress testing, and governance discipline may still function but it will lack resilience.

The real question isn't how bold your next investment looks.

It's whether it will still make sense 10 years from now under pressure.

Questions to Bring to Your Next Master Planning Discussion

• Are we reinforcing legacy or committing to strategy?
• What futures are we unintentionally eliminating?
• Does workforce probability support this footprint?
• Can this plan flex under financial stress?
• Will it survive leadership transition?

If these questions slow the room down, that's productive.

Resources Mentioned

• Riverside Health (fictional case study used for analysis)
• Workforce probability modeling
• Demand scenario stress testing (±10–20% inpatient sensitivity)
• Capital phasing stress simulations
• Governance deviation frameworks

About the Guest

Chase H. Miller is a healthcare strategist, planner, and architect focused on the intersection of long-term capital planning and organizational strategy. His work challenges health systems to think beyond facilities and toward disciplined strategic clarity, ensuring that capital investments reinforce resilience rather than embed fragility.

About the Podcast

The Architecture of Healing explores the intersection of healthcare strategy and the built environment. Each episode challenges leaders to think beyond square footage and toward the structural decisions that shape the future of care.

Learn more at:
Website:  https://www.thearchitecturofhealing.com
LinkedIn: https://www.linkedin.com/in/chase-h-miller/

If this episode sharpened your thinking, share it with a colleague navigating a master plan, and subscribe for future conversations on disciplined strategy in uncertain environments.

In this deeply personal and thought-provoking conversation, Adrienne Erdman shares her journey from biomedical engineering and human factors into architecture and healthcare design. As Director of Design Research at Ewing Cole and Vice President of Research & Development for the Trauma-Informed Design Society, Adrienne brings a systems-thinking, human-centered lens to the built environment.

The heart of this episode explores birth as a design challenge, not just clinically, but emotionally and operationally. Adrienne vulnerably shares her own birth experiences, highlighting how small operational breakdowns, sensory overload, and communication gaps can compound into trauma, even when clinical outcomes are positive.

We explore her recent national birth experience survey and the powerful "She Said" exhibit, which centers the voices of mothers through immersive storytelling. Together, we examine how healthcare designers can balance safety, personalization, emotional support, and operational efficiency to create spaces that truly honor families at one of life's most pivotal moments.

Key Takeaways

• 40% of surveyed mothers described their birth experience as traumatic even when outcomes were medically "successful."
• Experience does not equal outcome. Positive clinical results do not guarantee positive emotional impact.
• Human factors design examines biomechanics, cognition, psychology, sociology, and systems, and applies them to both products and spaces.
• Designing with people, not for them, builds trust, buy-in, and better outcomes.
• Maternity spaces often prioritize worst-case medical readiness over physiological normalcy and emotional comfort.
• Environmental stressors, lighting, noise, temperature, and interruptions significantly shape perception of care.
• Partner accommodations are frequently overlooked but critical to family-centered care.
• Access to maternity care remains fragile, especially in rural communities.
• Prenatal experiences are often inefficient and disruptive, presenting an opportunity for redesign.
• The future of healthcare must be holistic, integrating lifestyle, environment, nutrition, and lived experience.

Why This Matters

Birth is one of the only reasons a healthy person enters a hospital. It is a clinical event but also a life milestone, a family origin story, and a deeply vulnerable experience.

When design fails to account for emotional context, sensory experience, and operational nuance, trauma can occur even when clinical metrics look good on paper.

Healthcare design has the opportunity and responsibility to:

• Reduce preventable stressors
• Empower mothers as active participants
• Support partners and families
• Balance medical readiness with personalization
• Address trauma-informed principles in the built environment

As maternity services evolve from hospital-based models to birthing centers and expanded midwifery programs, design will play a pivotal role in shaping safer, more dignified, and more human birth experiences.

 The "She Said" Exhibit

"She Said", an immersive audio-visual installation featured at a Toronto colloquium on birth design.

Using quotes from nearly 400 U.S. birth survey respondents, layered with video and sound, the exhibit centered maternal voices rather than the clinical environment itself transforming research into emotional storytelling.

It represents a powerful example of research translation through design.

Rethinking Birth Spaces

Design opportunities discussed in this episode include:

• Reducing sensory overload in labor & delivery and OR environments
• Designing rooms for physiological birth first with hidden medical readiness
• Improving partner sleeping accommodations and room layout
• Allowing personalization and environmental control
• Supporting movement with tools like birthing balls, ropes, and tubs
• Creating prenatal clinics that respect patients' time and work lives

Resources Mentioned

• Trauma-Informed Design Society - https://www.tidsociety.com/
• "She Said" Birth Experience Survey (2023–2024)
• The Coaching Habit by Michael Bungay Stanier - https://a.co/d/0dNFnpBV
• Becker's Hospital Review (article referenced regarding rural maternity closures) - https://www.beckershospitalreview.com/finance/124-rural-hospitals-closed-labor-and-delivery-in-6-years-analysis/

About the Guest

Adrienne Erdman is the Director of Design Research at Ewing Cole, specializing in healthcare, and science and technology environments. With a background in biomedical engineering and human factors, she integrates research, systems thinking, and human-centered design into impactful architectural solutions.

She also serves as Vice President of Research & Development for the Trauma-Informed Design Society, advancing evidence-based approaches to trauma-informed design within the built environment.

Connect with Adrienne on LinkedIn: https://www.linkedin.com/in/adrienneerdman/

About the Podcast

The Architecture of Healing explores how strategy, operations, design, research, and human experience intersect to shape healthcare environments. Through conversations with executives, planners, strategists, architects, clinicians, researchers, and innovators, the show examines how space influences health, dignity, and wellbeing.

Learn more at:  www.thearchitecturofhealing.com

Connect with Chase Miller on LinkedIn: https://www.linkedin.com/in/chase-h-miller/

If this episode resonated with you, share it with a colleague, leave a review, and join us in reimagining healthcare environments that truly heal, not just clinically, but holistically.

Behavioral health crises are overwhelming emergency departments across the country.

In this episode of The Architecture of Healing, Chase Miller sits down with Dr. Scott Zeller, a psychiatrist and national leader in crisis care, to explore the origins and impact of the EMPATH Unit, Emergency Psychiatric Assessment, Treatment, and Healing.

Drawing from decades on the front lines of emergency psychiatry, Dr. Zeller explains how the right care model and the right environment can stabilize most patients in under 24 hours, reduce unnecessary hospitalizations, improve emergency department flow, and restore dignity to patients on the worst day of their lives.

Key Topics

• The rise of boarding in emergency departments
• What EMPATH units are and how they function in practice
• The role of environment and design in de-escalation and healing
• Emergency department throughput and operational efficiency
• Staffing models and clinician experience in crisis care
• Rural vs. urban scalability of EMPATH units
• Financial and reimbursement considerations

Key Takeaways

• Psychiatric emergency care is primarily a care model and environment problem, not just a bed shortage
• 75–80% of patients initially thought to need inpatient admission can stabilize within 24 hours in an EMPATH unit
• Therapeutic design reduces agitation, improves safety, and accelerates recovery
• EMPATH units improve ED flow while creating a better experience for staff and patients
• This model delivers better outcomes at a fraction of the cost of traditional alternatives

Why This Matters

If you work in healthcare leadership, emergency medicine, behavioral health, architecture, planning, operations, or if you care about how hospitals respond to people in crisis, this episode will fundamentally change how you think about emergency psychiatric care.

Resources & Links

• EMPATH Unit overview and implementation guidance - https://fgiguidelines.org/wp-content/uploads/2022/06/FGI-Design-of-BHCUs_2022-06.pdf
• Federal and Facility Guidelines Institute (FGI) Podcast - https://fgiguidelines.org/podcast/e5-behavioral-health-crisis-units-scott-zeller/

• Alameda Model - https://pmc.ncbi.nlm.nih.gov/articles/PMC3935789/
• Angle of Repose - https://www.goodreads.com/book/show/292408.Angle_of_Repose
• https://pmc.ncbi.nlm.nih.gov/articles/PMC8850530/
• EmPATH Summit - https://web.cvent.com/event/c9b818d9-d9af-4e75-bdbf-8edaa2d6f6e0/websitePage:0b77ccc9-e9f0-48f7-9010-45c9759b9324

About the Guest

Dr. Scott Zeller is a nationally recognized psychiatrist and leader in emergency and crisis psychiatric care, best known for pioneering the EMPATH Unit model—Emergency Psychiatric Assessment, Treatment, and Healing. With decades of experience on the front lines, including more than 20 years as Medical Director of Psychiatric Emergency Services in Alameda County, California, he has helped reshape how hospitals address behavioral health crises by aligning care models, environment, and rapid intervention to improve outcomes, reduce ED boarding, and restore dignity to patients in crisis.

Connect with Dr. Zeller - LinkedIn

Vituity -https://www.vituity.com/who-we-are/leadership/scott-zeller/

About the Podcast

The Architecture of Healing explores the intersection of healthcare strategy, design, operations, and experience—examining how environments, systems, and decisions shape care delivery and healing.

www.thearchitectureofhealing.com

Connect with Chase - https://www.linkedin.com/in/chase-h-miller/

In this episode of The Architecture of Healing, Chase shares the "why" behind the podcast and explores one of the most significant shifts in healthcare today: the rise of ambulatory surgery centers and the policy changes accelerating care out of the hospital.

From the origins of ASCs to the 2026 CMS rule and the phased removal of the inpatient-only list, this episode breaks down how regulation, reimbursement, and strategy are reshaping where surgery happens and what that means for hospitals, outpatient facilities, and the built environment. A systems-level look at designing for flexibility, value, and the future of care.

Key Themes & Takeaways

·         ·  Why The Architecture of Healing exists

·         ·  The evolution of ambulatory surgery centers

·         ·  The 2026 CMS rule and the inpatient-only list

·         ·  Impacts on hospitals, ASCs, and surgical strategy

·         ·  Designing flexible environments for shifting care delivery

Episode Resources

·         CMS 2026 Final Rule overview and inpatient-only list updates - https://www.cms.gov/medicare/payment/prospective-payment-systems/acute-inpatient-pps/fy-2026-ipps-final-rule-home-page

·         Historical background on ambulatory surgery centers and outpatient surgical care - https://www.ascassociation.org/advancingsurgicalcare/asc/historyofascs

·         Articles and research on site-of-care shifts and outpatient surgery growth - https://ascnews.com/2025/12/asc-final-rule-outpatient-surgery-shift-continues-to-spark-concerns-over-medicare-access-to-post-acute-care/

·         Planning and design resources related to ASC and hospital co-location strategies - https://www.beckersasc.com/asc-transactions-and-valuation-issues/the-perfect-storm-for-asc-expansion-is-coming/

Connect & Continue the Conversation

Visit thearchitectureofhealing.com for more episodes, insights, and resources on shaping the future of healthcare through strategy, design, and operations.

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