By BETSY TAYLOR
When building a hospital, MASS Design Group subscribes to the philosophy that there's no such thing as neutral architecture — it either contributes to or impedes healing.
Murphy
Michael Murphy, co-founder and executive director of the nonprofit architecture and design firm MASS Design Group, and a keynote speaker at the Catholic Health Assembly, says the built environment shapes people's lives every day in both obvious and incremental ways. Great design in health care buildings, he says, can reduce the spread of infection, improve outcomes, and lead to systemic change in communities.
Murphy was studying at the Harvard University Graduate School of Design when he heard a talk by Dr. Paul Farmer, the co-founder of Partners in Health, a health care organization well known for its international work treating the poor. Murphy asked about who was doing design work on the organization's clinics and was told Farmer himself had roughed out the last one out of necessity.
MASS Design Group got its start when Murphy, company co-founder Alan Ricks and others worked in 2008 to design and build the Butaro District Hospital in Rwanda, a project of Partners in Health and the Rwandan Ministry of Health.
The organization has gained notice for its approach and its execution. Much of its work has been in the developing world. MASS Design Group believes design decisions provide opportunities to invest in the dignity of those who will be served by the design, and in the community where it is located. The organization sources materials and labor locally and says it strives to create buildings that improve and strengthen communities.
A tall order
Murphy says MASS Design Group thinks about how a building shapes health in terms of three scales:
- "There's the health of the body, how the function of the building specifically makes us healthier or sicker.
- "There's the scale up — which is the health of the community. How does the building, and particularly the building process — the way it's built and who builds it — shape a broader and healthier composition to our community and community relationships?
- "The third is the scale of the nation or of a system. How does the design of the building (go on to) shape an approach to policy, or an improving of health care, or health care infrastructure, more broadly?"
Community investment
MASS Design Group designed that first project in Rwanda, to reduce the transmission of airborne disease, with natural cross-ventilation and design decisions related to patient and staff flow. The hospital was built using volcanic rock from the area, employing local labor and area building techniques.
In the years since, four individual homes and three units of communal-style housing were built adjacent to the hospital to provide comfortable accommodations to attract a rotation of doctors and retain medical staff in a region that long didn't have access to quality doctors, according to MASS Design Group's website.
As another example, Murphy talks about MASS Design Group's work on a cholera patient treatment center in Port-au-Prince, Haiti, for GHESKIO Centers, the Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections. (The nonprofit got its start treating HIV and AIDS patients.) Prior to the opening of the cholera treatment center, many patients were treated in hot and sometimes unsanitary tents, according to MASS Design Group's website.
The cholera treatment center has a straightforward public health goal: fewer people contracting cholera. Murphy says it was built using resources and assets of the community. And while the firm couldn't reform the city's water and waste infrastructures to eliminate cholera transmission, it took a step in that direction. MASS Design Group installed a micro-wastewater treatment facility at the center.
Murphy says since the cholera treatment center opened in 2015, residents in adjacent neighborhoods, about 70,000 people in the treatment center's catchment area, have been continually cholera-free, though cholera remains a problem in Haiti.
Murphy says for good and bad, medical facilities are often the manifestation of the medical system itself. Rethinking the design of health care buildings can require rethinking the complex and hard to navigate medical system. "A great building represents a great system that is functioning," he says.
MASS Design Group collaborated with obstetrician Dr. Neel Shah and the Ariadne Labs for a recent report on the impact of design on clinical care in childbirth. It specifically examines design decisions that may impact cesarean-section delivery rates at a facility. Ariadne Labs, whose executive director is surgeon, author and professor Dr. Atul Gawande, is a collaboration between Brigham and Women's Hospital and the Harvard T.H. Chan School of Public Health.
MASS Design Group has offices in Boston and the Rwandan capital of Kigali. It has projects in about a dozen countries including the United States.