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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. Follow The Architecture of Healing on: Website → thearchitectureofhealing.com YouTube → @TheArchitectureofHealing LinkedIn → @TheArchitectureofHealing

Healthcare organizations spend millions—sometimes billions—on capital projects intended to improve care. Yet too often, those investments address symptoms rather than root causes. In this episode, Chase Miller sits down with Bill Hercules to explore how healthcare capital strategy, finance, and design intersect—and why architects must learn to think like executives if they want to influence real outcomes. With decades of experience across healthcare architecture, executive leadership, and professional advocacy, Bill offers a rare systems-level perspective on how hospitals make decisions, how capital really flows, and why understanding finance is essential to designing environments that truly support care. Key Topics Covered ·         Why healthcare organizations frequently solve the wrong problem with expensive buildings ·         The difference between capital strategy and capital reaction ·         How CEOs and CFOs evaluate healthcare design investments ·         Why "form follows finance" is often more accurate than architects want to admit ·         The hidden risks of expanding emergency departments instead of fixing operations ·         How functional programming reveals the real purpose of a project ·         Translating evidence-based design into a business case executives understand ·         The limits of codes and guidelines in delivering healing outcomes ·         The ethical implications of ignoring design research ·         How competition, deregulation, and data are reshaping healthcare planning ·         Why healthcare buildings are tools—not the mission itself Key Takeaways ·         Capital strategy is diagnostic, not reactive. Expensive expansions often mask operational failures rather than fix them. ·         Healthcare executives think in systems, not spaces. Architects who understand finance, operations, and incentives earn credibility. ·         Evidence-based design only matters if it can be translated into value. Research without financial context rarely drives decisions. ·         Functional programming is one of the most powerful—and underused—tools in healthcare design. ·         Healthcare organizations are not in the building business—they're in the care business. Architecture succeeds only when it supports that mission. ·         Solving the right problem matters more than designing the perfect solution. Notable Quotes ·         "Healthcare systems are not in the building business—they're in the care business." ·         "If you don't understand the financial drivers, you'll lose the conversation every time." ·         "Expanding the ED is often a symptom-based response to an operational disease." Resources & Concepts Mentioned Ken Cates Functional Programming Podcast - https://fgiguidelines.org/podcast/e2-the-functional-program-ken-cates/ The Center for Health Design - https://www.healthdesign.org/ The Center for Health Design Knowledge Repository –  https://www.healthdesign.org/knowledge-repository Form Follows Finance – https://www.amazon.com/Form-Follows-Finance-Skyscrapers-Skylines/dp/1568980442 The Bible   The World Health Organization - https://www.who.int/ About the Guest Bill Hercules is a rare triple-Fellow of the AIA, ACHA, and the American College of Healthcare Executives. With more than three decades of experience, Bill helps healthcare organizations align capital investment, operational strategy, and design excellence to improve long-term outcomes. Connect with Bill – https://www.linkedin.com/in/billhercules WJH Health - https://www.wjh-health.com/   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/

Healthcare innovation is moving faster than ever, but speed doesn't always equal progress. In this episode, Chase Miller sits down with Erica Parker, a human factors leader whose career spans healthcare architecture, product design, and enterprise innovation at Memorial Sloan Kettering and MD Anderson. Together, they explore how human factors and human-centered design help healthcare organizations evaluate emerging technologies, reduce risk, and implement AI in ways that truly improve patient and staff experience. This conversation challenges the assumption that more technology is always better, and offers a grounded framework for leaders navigating the future of healthcare innovation. Key Topics Covered What human factors really means in healthcare—and why it's often misunderstood Lessons from speculative design and the Breaking Through competition Why many "innovative" healthcare technologies fail to scale The difference between radical, disruptive, incremental, and adjacent innovation How AI can unintentionally increase cognitive load and operational risk Why education, staffing, and workflow readiness matter as much as technology Governance, intake, and lifecycle management of AI in healthcare systems Evaluating vendors, pilots, and emerging tools responsibly The risks of automating human connection out of healthcare Why ambient listening, AI agents, and automation require clearer expectations The future of healthcare data—and what patient ownership could unlock Key Takeaways Just because a technology can do something doesn't mean it should—especially in high-reliability healthcare environments. Human factors bridges the gap between innovation and safe, effective implementation. Constraints drive better innovation—incremental improvements often create the greatest day-to-day impact. AI must be evaluated at a systems level, not as isolated tools. Education gaps can undermine even the best-designed technology. Healthcare's future depends on governance, readiness, and trust—not hype. Memorable Quotes "Just because the technology can do something doesn't mean that's the right direction to go." "Innovation isn't about shiny tools—it's about improving safety, performance, and satisfaction." "Sometimes the problem isn't the product. It's education." "The future of healthcare is data—and eventually, patients will own it." About the Guest Erica is a human factors leader with a background in healthcare architecture, product design, and enterprise innovation. She has worked at Perkins Eastman, Memorial Sloan Kettering Cancer Center, and currently supports AI, operational intelligence, and human-technology interaction at MD Anderson, focusing on safety, performance, and scalable innovation. Connect with Erica - https://www.linkedin.com/in/elparchitecture/ Breaking Through Competition - Aroma Breaking Through Competition - G.I.S.M.O. 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 - htt114ps://www.linkedin.com/in/chase-h-miller/

In this thought-provoking episode, host Chase Miller welcomes Dr. Addie Abushousheh, a designer, researcher, and environmental gerontologist whose research sits at the intersection of neuroscience, organizational development, and healthcare design. Together, they unpack how environments act not merely as backdrops for care, but as active participants in the healing process. From her unconventional career path and early work in traumatic brain injury units to her leadership within the Facilities Guidelines Institute (FGI), Addie shares how evidence-based, human-centered environments can empower both patients and caregivers. Her insights challenge conventional thinking about architecture, healthcare operations, and what it truly means to design for "our future selves."   Key Themes & Takeaways 1. The Environment as a Therapeutic Tool Spaces aren't neutral, they can either enable or disable human potential. Addie's work in traumatic brain injury rehabilitation revealed that intuitive design cues like contrast, lighting, and layout can reduce dependency on staff and improve independence. "When the environment functions like a prosthetic, it restores ability rather than reminding people of their limitations." 2. The "Competence-Press Model" and the Zone of Adaptation Derived from Powell Lawton's environmental gerontology research, this model describes the relationship between a person's capability and the complexity of their environment. The sweet spot, the zone of adaptation is where people perform and heal best. Too much simplicity can disable capable individuals; too much complexity can overwhelm the vulnerable. 3. Rethinking Age-Friendly Health Systems CMS's "Four Ms" framework; mentation, medication, mobility, and what matters most guides age-friendly healthcare. Addie argues for a fifth "M": multi-complexity, acknowledging the layered needs of aging populations. Despite strong evidence from environmental research, the built environment is still missing from these national quality frameworks. 4. Building the Business Case for Design The ROI of evidence-based design can and should be measured. Addie encourages leaders to evaluate the cost of inaction: falls, turnover, never-events, and inefficiencies. Embedding "evidence-based design sheets" into construction documents helps preserve crucial interventions through the value-engineering process. 5. Dementia-Friendly Design Is Just Good Design Addie and Chase's collaborative project - the Dementia-Friendly Waiting Room, proved that low-cost, high-impact design moves can dramatically reduce anxiety and confusion. Adjusting color contrast, lighting, and furniture placement enhances safety and comfort for everyone, not just those with cognitive decline. "Designing for dementia is really just designing well for humans." 6. Shaping Policy Through the FGI As co-chair for the Residential Healthcare and Support Facilities guidelines, Addie helps define national design standards. The upcoming 2026 FGI update will include expanded sections on mental and behavioral health and clearer language for sensory processing environments, a huge step toward more inclusive care settings. 7. The Future of Healthcare Is Everywhere Healthcare doesn't exist in isolation; it's embedded in cities, homes, workplaces, and justice systems. Addie's example of a memory-care ward within a correctional facility, where inmate caregivers received CNA training, showed a 60% drop in recidivism, demonstrating how design can transform both health and society.   Memorable Quotes "If you value something, you evaluate it." "If we aren't actively enabling our future selves, we're discriminating against ourselves in advance." "Designing for dementia isn't niche, it's simply designing for humans." "The future of healthcare is everywhere."   Lightning Round Highlights Favorite healing space: A New York camp called anthroposophy, designed to cradle patients in light and acoustics. Book that changed her life: How to Win Friends and Influence People by Dale Carnegie. Inspiration outside of work: Observing how people interact with spaces in everyday life. The future of healthcare: "Everywhere."   Episode Resources Learn more about the Age-Friendly Health Systems initiative: IHI.org/AgeFriendly Explore the Facilities Guidelines Institute (FGI): fgiguidelines.org Book mentioned: How to Win Friends and Influence People by Dale Carnegie Connect with Dr. Addie on LinkedIn   Connect & Continue the Conversation Visit thearchitectureofhealing.com for more episodes, insights, and resources on shaping the future of healthcare through strategy, design, and operations. Follow The Architecture of Healing on: Website → thearchitectureofhealing.com LinkedIn → Chase Miller LinkedIn → @TheArchitectureofHealing

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.