CCB: Welcome back to the ONEder Podcast, where we explore the people and the ideas shaping the future of environments for learning, healing, and community. Today we're diving into the powerful intersection of design, research, equity and healthcare with someone who's lived it from both sides of the bedrail. (Okay, that made me laugh. Sorry.)

Terri Zborowsky began her career as a nurse before becoming a nationally respected healthcare design researcher and strategist. She brings a rare, dual perspective, grounded in clinical experience and fueled by a passion for creating spaces that communicate dignity, safety and belonging.

Terri believes design is never neutral and she's made it her mission to ask better questions. Engage communities with care and help healthcare teams see space not just as infrastructure, but as a reflection of values, whether you're a designer, clinician or someone who simply wants to create more humane and equitable spaces.

This conversation will definitely open your eyes and your heart to what is possible. Let's get started. I want to say welcome, Terri. We're so glad to have you join us.

Terri Zborowsky: What an absolute honor. Thank you.

CCB: I'm going to preface this by saying we have worked with Terri before, so I'll be interjecting little thoughts and comments in here. But Terri, you started your career as a nurse, so help us understand what first sparked your transition from direct patient care into the world of design and research?

Terri Zborowsky: Well, it was very, uh, circuitous, I would say. I decided after being a bedside nurse for many years. That I was burnt out and I wanted to leave nursing and to go back to school, become an interior designer.

So my intent was to become an interior designer. And I just want to preface that by saying this was well over 20 years ago when HIV and AIDS was an acute illness, not a chronic illness as it is today. And what I was seeing when I was in school, we were proposing to do a major project and we had to pick our topic and I was so distressed as a nurse seeing all of these like designers creating hospice care rooms for people with HIV and AIDS at a time when I really understood that there was so much life in the illness left, and that just providing spaces for people to die was great, but was not the only need. And it's really then and only then in my last year of interior design school, that I realized and put the connection between my nursing history, my nursing career, my nursing education, and understanding spatial needs for people with HIV and AIDS.

I went on to study that area for about 10 years that led me to graduate school and here I am today. But it was really how I, really how I left my former career and without really knowing what embarked on this amazing journey of a career that I've had in healthcare design.

CCB: And amazing is like a totally appropriate word when we think about, uh, everything that you've touched. And you just kind of referred this, but can you describe a moment where you realized that the environment itself could be a tool for healing or harm?

Terri Zborowsky: Actually, I'll give you an example so everybody can see it for themselves. I want you to think about a moment when you have been in a space or a place. Could be nature, could be outside, could be inside, in which you feel awe inspired. So, some spaces that come to mind for people are like spiritual spaces, maybe a church, a mosque, um, uh, sometimes for people that's being in nature, being near water. That's something, where you understand the healing power of the place around you, and that's why I think everybody can connect with that. And to me, that's the essence of the power of design.

CCB: Wow. I will say, Terri, you were on a panel about designing for health equity, in our office, which was a profound conversation and there were so many moments that kind of touched everyone in the audience, and you posed a beautiful question during that panel that said, “picture a place where you feel like you belong.” What does it smell like? What does it sound like? Why is engaging the senses so important in equity focused design?

Terri Zborowsky: Well in, in my world, it's how we take information in. Our senses, bring to life, uh, the space, as the people we're with, the food, we're smelling the flowers outside. Um, the way that we see, we hear the world, that's how we understand it and make sense of it. So when we design it, we should always be very aware of how others view it as well, because it's through their lenses that we start to begin our understanding of how others in a different time and space to us, whether they have their, may have vision impairment, they may have a different ethnic background. They may have, uh, come from a completely different part of the country. Understanding their experiences, their sensory experiences helps us understand how to create an environment that really, um, creates an area for people to feel belonging, welcoming, inclusion, and I think it's really the senses that we have that create those memories for us. And by understanding how others have created those memories.

I remember reading this research article many years ago and it said, our brain creates the spatial framework for memories. Like everybody, maybe not these days, but used to remember when you said, “oh, where were you when JFK died?” Everybody had a memory of a place and a time who they were with. And it's those kind of memories, those sensory memories that, that feed us, that information about how we feel in that moment. And it's only through understanding how others and starting to understand how others feel that way, really helps us ground our ways to create environments for all.

CCB: Okay. I'm going to put a little note in here that there is, for every one of our podcasts, there is a web page that has all sorts of links, so you'll be able to catch up with more of Terri's contact information. She is a design researcher with HGA and there will be a link, her LinkedIn profile, et cetera, et cetera, et cetera. So you can always refer back.

So I want to say, you also said before that design communicates values and you’re kind of making that link between, you know, how we are in the world individually and then how we are in the world, you know, in kind of, in community. In your experience, um, what kinds of design choices, big or small, can signal inclusion or exclusion, in healthcare spaces specifically?

Terri Zborowsky: It's a great question, and I'm going to give you another example from my own personal experience. Um, many years ago when I was doing a little bit more upfront medical planning in healthcare, I was assigned to work on an ambulatory care building for a healthcare system that dealt specifically with children, as in pediatric.

And it was really beyond my, I'd never experienced this before, but I was. And when we met with the client, they said, look, we really know that you all get how to design, but we want our patients and families to be in each user meeting from the very beginning of the design to the very end. And this was before, this was sort of a commonplace thing, and I thought, oh, great. I was skeptical. I'm like, we're all parents. You get what I mean, most of us, we're parents. I, I understand what my kids need. And when we had our first meeting, we were talking with our patient family rep, who by the way became a close personal friend of mine after, who, um, who through her experiences in life had an older child that had been seen through this children's hospital.

And I said, oh, well, you know, how many, how many toilets do you think we need? Like, you know, the toilet stalls in this ambulatory care building. And she said to me, oh, I don't care how many of those you put in. I need a private changing room for my child. And I said, this was before that was a thing, like an adult changing table she was describing to me.

And I said, oh, that's so much space and it costs so much money per square foot. And she said to me, well, let me tell you, or better yet what, you can come with me if you want and see how I have to change my child. Currently in that situation on the floor, I have to bring garbage bags with me from home so I can put her on the floor in an open stall bathroom.

And the humiliation and the shock and awe with people walking in and here she is changing an adult child. Um, it's really then that I realized, honestly, that how our design choices that we make, affect and reflect how we value the user's needs in space, how we impact people's humanity, how we impact people's sense of privacy and need for allowing them to have, uh, an experience that's different from ours.

I mean, now they're commonplace in Minnesota. They're actually regulated in public buildings to have large, uh, adult like change table private bathrooms. Um, but that was a game changer for me, and ever since then, it was a toilet that started to sway my thinking in how we really can give back to people when we understand what their needs are. We can really start to give back through design and uh, I think we, it behooves us to do that.

CCB: Your participation in that panel, which I'm going to refer, keep referring back to, and I will include the blog post in the links that talks about the full conversation, but, we were really looking at, you know, designing for health equity and what does that mean?

And you are just talking about marginalized communities and that can run such a wide gamut of what is marginalized. And so what does true co-design with the marginalized communities kind of look like? Like what are some of the common missteps (and you're just like talking about it right now) to avoid.

Terri Zborowsky: Well, I don't know if I have all the answers, but I, I do have some good suggestions that I've learned along the way, and the first one really is to know your community that you're designing for. And that's not just the facility that you're designing for, the organization, the company. Know the local community within which that sits.

Start to understand, who the under, where the underserved community populations are. It's very important for us in healthcare design to recognize where underserved communities are, and how we might be able to impact them through the design and ways in which we can do that very creatively, but bringing their voice to the table is the first step.

The second thing I would recommend to people is that you think about yourself, that you spend some time doing some self-reflection before you work with any kind of, uh, population that you do not belong to. You need to ask yourself, am I the right person to lead this discussion? If not, it doesn't mean you can't participate, but maybe you bring others along that help represent that community and have more of a synergy with that community than you do.

“Do I know enough about this community to be able to bring their point of view to the table? And how to ask the right questions in the right way that elicit the kind of responses that you want. And also make sure to consider is there a power differential? Um, and this applies in all different kinds of settings. It doesn't mean anyone's bad. Or good. It just means a real self-reflection on who you are and how you sit within a particular kind of community.

A few more things. Be authentic, always. I mean, I would rather stumble through something and be myself than try to be someone that I'm not and try to speak to people in a way that I'm not comfortable with. So really be authentic. People will forgive you for that, and they will love you for it. I, trust me, meet people where they're at. A lot of times we meet with families and their, uh, loved one that's the patient. Sometimes they can't make it to the facility or to a specific place, and actually a virtual meeting is better for them because they're at home.

If they have a chronically ill child, if they have an, uh, a child that is on the autism spectrum disorder, getting around is harder for them. So asking them where they'd like to meet, don't assume that they all want to come and flock to where you are, and make sure you're meeting them at a time that works. Many of these families work full time and so making sure that you make time sometimes in the evening that you have to go and meet with them, um, because you're extending your hand to them. You need to be gracious for their time, and I always ask people to please provide, um, who I'm working with, that we provide a gift card of some kind or a meal for people.

We give them something because they're giving of their time and their thoughts. We, we really need to be gracious about that and just be a good host or hostess.

CCB: It's such an interesting framework that we're talking about - designing for health equity, when what you're talking about is, you know, is human dignity and crosses all borders, and is not specific to any particular industry or activity. But, um, gosh, I'm very moved and I think I was thinking about, I have a role outside of my regular work as a patient advocate, as a research patient advocate, and that's representing the patient population in conversations around a particular illness. And what is asked of me on a regular basis is to be the voice for a larger population.

And it made me have to jump over fences, do that self-reflection, because I may want information given to me in a certain way, but I'm not, not the only patient that's receiving the information. So it's just fascinating to really have to stop and think. And I love your encouragement to be authentic and everyone's authentic self is so much easier to work with than trying to, you know, trying to perform as something else. Because then it's performance and it's so much harder to connect. So thank you very much for all of that information.

Terri Zborowsky: I, I just want to tell you a little funny story. I was doing some focus groups for patients and families in the Midwest in a very small town. I come from a family where we dressed and wore heels, and that was just my family background, right? And so of course I went to this focus group in this Midwestern small town and everybody kind of had runners or um, tennis shoes on. And here I am in these high heels and like a suit jacket and blah, blah, blah.

And this woman comes up to me after I, we had done the focus group and she hugged me. She said, dear, it was hysterical to watch you try and walk around for three hours on those heels. But that was me, that I love that comment, that was just me being authentic and her recognizing like, you are not from around here.

CCB: And yeah, and it does open doors and what, that's what we're talking about.

Terri Zborowsky: Speed to trust. Speed to trust. Yeah,

CCB: Exactly. Moves to trust. Okay, so now we're going to take a little bit of a turn here and talk about kind of the research and action. And hospitals are required to conduct community health needs assessments, also known as CHNA. But these often sit on a shelf once they're completed. So how can designers activate this data in meaningful ways?

Terri Zborowsky: Well. Here we go. Designers run to your local CHNA. Look it up under your facility or community. It's usually under facility name. They're redone every three years, so make sure you have the most current version. Just there's FYI. Why are they important?

They're so important because what they do to complete a CHNA is they bring the voice of the underserved, medically underserved populations to the table. They interview them and ask them, and the local communities, which support a lot of the underserved communities, what kinds of needs, what are the health disparities in this community? And help us understand how we might overcome some of them.

Um, this is, uh, a very major undertaking and it's very important for us, uh, coming from an outside community into another community, to help us understand things like access-to-care issues. It helps us understand, um, the troubles that seniors are having in getting transportation to get to their doctor's appointments.

It helps us understand the behavioral health complexities of that specific population and some of the abuse issues going on, the addiction issues going on. So when you read it and you're thinking about it, I want you to think about, and I think it will come to you very quickly, but here's my challenge: How do I translate this information into design?

Well, let's just jump back a little bit earlier to a question we just talked about. How does design heal? What's healing to you? What are healing spaces and healing features? A lot of these communities that are dealing with a lot of the inequity in healthcare are traumatized communities.

I think of my own community in Minneapolis and the post George Floyd, uh, trauma that we all faced and, and that was a national trauma, but it really speaks to the need when we went back in to do a local hospital, design, a local hospital there to think about how we can help heal that community through design.

So it comes at many different levels, and it comes in many different ways, but getting into the information about the community really helps you to understand what that community is struggling with, and ways in which those healthcare systems are trying desperately to rightsize that inequity that we see every day.

CCB: Wow. Um, I'm also, I'm going to make another little pitch here for our listeners to definitely check out the page of the website, that's, uh, talking about this particular podcast, because there will be links again to that overview of the healing design equity conversation panel that we met Terri through.

And there was a representative of a major health system who had the same heartfelt intention, and speaks to how difficult it might be to work through the system, since the health systems often create their own stumbling blocks, let's just say that by virtue of being bureaucratic in large organizations. Uh, okay, so you have worked at the intersection of research and architecture and operations, so how do you see design influencing systems-level change in healthcare, speaking to that exact point?

Terri Zborowsky: Well, that's a great point. So, I think that we can start to understand it as designers when we recognize the power of design and that design has to become part of the equation. So when we're thinking of, you know, systemic issues that occur within any kind of org, large organization, we have to think about it in this way. There are People, there's Place, so it's the design piece, there's Processes going on, and then there's Technology. And all of those things I think about have to come together. And think of a Venn diagram, and right in the center is that healing environment component.

Once you have the people in the right place with the right kind of infrastructure to do the right things, the right processes and the technology that can support them, I think that's when design starts to sing. Now how do you get there and how do you know? Um, well. We, we at HGA prescribed to a lot of LEAN technology or techniques, and one of them is called ‘going to gamba’.

‘Going to gamba’ is a LEAN term from the Toyota manufacturing line. That means going to the work, and that's what we typically do whenever we start any project is we go and we look at what is the current state. We follow the work, but we don't follow the work at the administrative level. Not that I don't love administrators and they do have their own work flow and of course a huge purpose in what, what they're doing.

We follow the people who are doing the everyday work, the transport people, the med pharmacy techs who run the, the medications up to the floors, the nurses who are doing the bedside care. And when you do that over and over again and you start to really understand what their process and flow should be, you then, as a designer, start to recognize how the design enhances or inhibits that workflow. And those are those kinds of systematic or systemic changes that need to occur, then your role then is to start to point that out to the people in the design team. Document everything and start to say, okay, here's some of the, we'll call them bottlenecks for now, that are, that are inhibiting this workflow, these experiences even from happening the way that they should.

What can we do in the new building in order to get past that? And what should we do? I want to point out too, um, that design impacts these flows, and I'll call them experiences as well as, is impacted by these flows and experiences. And so then you all need to sort of step back at the end of that and go, “what needs to change? How do we make this happen?

And how, what is the role that design, and the people and the process and the technology play in enabling a better flow for not just the staff, for the patients, for everybody involved. Um, for the, the maintenance people; their role is vital in healthcare facilities to keep it clean, and we really need to understand how they do their job as well.

So, it's really understanding all those flows together that help us see what those systemic changes that are needed to happen.

CCB: Okay. I have a trick question for you that I'm just going to throw in here, which is, is there an all-time favorite project that you've worked on? One.

Terri Zborowsky: Hmm. I, I think through the years I've been graced with so many wonderful lessons learned and opportunities throughout, but definitely the first one I mentioned, the Children's Hospital was one of my first projects doing it on my own and the lessons that I learned by being able to be open to listen, to walk through the eyes of someone else's experience and to learn to deepen my own empathy. That was probably the very first one.

And then every single time, I know this might feel cliche-ish, but every single project I have the honor of being a part of and helping to elevate the voice of the users in, to make the design decision-making, not the typical users, not the CFO. I love CFOs too, but the people who are actually in the weeds, the community members, the staff members doing the work, when we can elevate their voice, they're all, they're all very special and unique.

CCB: Thank you very much. Alright, um, another little pivot here. What emerging trends or research areas are you most excited about when it comes to designing for health equity?

Terri Zborowsky: Well, I've thought about that in this way. I think the current trend that we're on right now, which is talking and explaining and increasing awareness of what diversity is within our own communities and other communities. Starting to understand, more about, um, you know, populations that we may not have had access to growing up.

Maybe not our neighbors, but really the whole, um, really embracing of any underserved population and our ability to go out and actually learn from someone else that has a different experience from us. Really what this does, this increased awareness is, it provides an opportunity for all of us, again, to see the world through a variety of lenses.

And to choose if we want to deepen our own empathy for others by asking questions, by, um, you know, uh, having experiences with people and helping to understand how they, how their world is shaped and what that might mean for them. When you think about like populations that come from countries where there may have been torture and trauma. No one knows that. No one drives past someone's house and says, oh, there's a family that's been traumatized by their, you know, because they were a recent immigrant from a country. Um, but once we can all sort of come out and talk to each other and start to understand, and what that means for people, and what having been through trauma means for people, not just in healthcare, of course, but as you said earlier, for all spaces.

I think, it's really a wonderful opportunity for us all to grow ourselves and to create environments that really can reach people, and can have meaning and deep meaning for them. Um, the second trend is transparency of data that we're seeing. So I know that some people, it's very, it, they're on the fence with this because there's a lot being shared out there right now. But I'm going to tell you why I think it's important that we have some transparency of data.

Um, what that does, so for example, if you think of the CHNA and you think about population statistics and demographics, and what that does is help us start the conversation, right? It's like how we can see who the people are that are going to be the users of this facility. How we can try to reach them and what kinds of questions we can ask. How is your experience different in life? What kinds of, what kind of colors are important to you culturally even, you know, color’s a hard one 'cause it's, there's a lot of cultural underpinnings to color. So all of those things have so much meaning for us. And, and it also makes me, uh, think about, I was at a recent health equity conference, uh, it was put on by Harris Health, who was doing a lot on health equity within their communities Because I heard a, a statistic I couldn't even believe. So here's the data and if you live in the Fifth Ward in Houston, which is a historically um, historical neighborhood, you are likely to die 20 years younger than anybody else in Houston.

Like not five, but 20. And why, why is that? That's because there has been a neglected environment, conditions that have impacted the population health of all of that community as well as access to care. So Harris Health is building a new hospital out there to help bring in, like they don't have enough green space, they don't have enough uh, garden spaces, they don't have enough access. Issues like how do people get transportation? And so that data helped inform the kinds of things that helped Harris Health create a new hospital to help serve some of that community.

Um, another local community that we, we did research in was in Cleveland at Metro Health in Cleveland, Ohio. We conducted some research. So they just built a new hospital and they decided to reach out into their local community. They have over a thousand pieces of artwork in this hospital. About 70% of it is from local artists, and they wanted artists to just bring art to them that reflected the community, and we did some research on why that created a, if it did, create a sense of welcoming, belonging, and inclusion.

And of course it did, but it was so wonderful to see communities using their data, understanding who their community members are, and reaching out into those communities. To bring everybody back to the table to say, how can we make this be a space and place that really serve the community members? But I'll argue that it's the demographics and some of the population health components that help us understand how to do that.

CCB: Wow, Terri, we could sit and talk forever, but we've reached the end of our recording. This is just amazing. I love conversations with guests on the ONEder Podcast who completely engage and share deep, profound, and personally passionate information. It's just fabulous, and you are fabulous.

Terri, you have the last word. Is there anything that you'd like to share as a final thought?

Terri Zborowsky: Boy, do I, but I'll try to keep it short. What I would hope to give to people by listening to this and finishing listening to this, really two pieces of knowledge that I've learned through the years. There is power in design. Just think of things that inspire you.

You will immediately think of things within the built in the natural environment, but we don't, we spend 90% of our time inside. So most of our access to outside, well we do have some, is through inside. And it's the ability to have that view, to have those, those, you know, those beautiful accesses to nature that we have. And so remember that, that there is power in design.

And then secondly, do something. Just do something, take a chance. Um measure it, do research on it, share it with others. I've shared even our worst stories of, of that. I have been a researcher for so many years, and not every research study has been successful, but wow. Amazing to know what things might have gone wrong and how others can avoid that. And you still always get…there's some golden nugget in every opportunity, every project, every research project that you get to do. So just go ahead, walk through the door. I'm going to give you permission.