“Design Everything” has been a core value of the company since the beginning. We mean a lot of things when we talk about this within the company, and new employees quickly learn that design is not how something looks, but rather how something works. Crossover broke into the employer care industry by leading first with our Experience Platform. Our architectural and design elements were the most obvious manifestation of that ethos, and I thought it would be pretty interesting to share some additional background and insights into the partnership that has enabled us to continue to push the boundaries in this area.
For almost a decade, we have had the privilege of working with Howard Kwok, a senior architect at DES Architects + Engineers in Redwood City, CA. Howard has been closely involved with Crossover Health since our first Wellness Center at Apple nearly 10 years ago. He’s had a front row seat to the growth and evolution of the company, and has led the expression of Crossover’s strategy through the design of both our onsite and nearsite health centers. And, in spite of the craziness of working with us, he’s managed to stay on the rocketship while continually producing exceptional work that has kept us on the leading edge of healthcare design.
Given this long-standing partnership, and Howard’s very unique perspective, we thought it would be awesome to get his thoughts on creating our experience over the last decade. As a healthcare architect, he has seen the changing nature of healthcare in general—and primary care specifically—as well as the changing relationship of physical space to an increasingly digital world. He has been a phenomenal business and thought partner, a creative problem-solver, and a catalyst in helping deliver our XO Magic. In the end, Howard has helped us tell our story through the medium of architecture and has become a key pillar in our “experience platform.”
We hope you enjoy his insights, humor, and just good human-ness as much as we do!
How did you first meet Crossover?
I had already been doing some high-grade, but still very traditional, health clinic work for several health entities in the Bay Area. One day we got a call from Apple who asked DES to help them design their new wellness center. Apple already had another design in place but it was pretty traditional, and when they selected Crossover, they were willing to experiment with some of the new and creative concepts that Crossover had proposed to them. I didn’t really know what a “wellness center” was, but after meeting with Rich Patragnoni, MD and Scott Shreeve, MD, I realized these guys really wanted something entirely new and a very different approach.
What was really different about the design you created?
Apple allowed us the time necessary to really study out a new approach. We had a clean sheet of paper, were not constrained by any set standards or specifications, and the Crossover team was allowed to provide quite a bit of input. We had a fairly substantial delay with the lease for a proposed site, which turned out to be quite helpful. It allowed us to do something a project timeline rarely allows, which was to spend six months studying new ways to make a health center less institutional, less stressful, and of course, more efficient. We even got to build a mockup clinic inside of another building on the campus to test out new concepts with the exam and consult rooms, test the sizing and spacing constraints in real time, and go through multiple iterations as a team, finding the exact balance that we all had envisioned.
What were the biggest improvements this process enabled?
We did lots of things differently but I recall two really big ideas. One was the dual access exam room concept—this allowed one entry door from the public area and one separate door from the staff area. The Crossover guys had seen this at the University of Utah in their Primary Care service and really liked the flow and dynamic it created. The other was the concept of a shared “bullpen” for the staff. The patient room had quite a few efficiencies built into it (spacing, storage, lighting, etc.), and the functional bullpen by design, ensured all the providers literally worked together as a team. By removing all private rooms, and giving them a significant, central space, we created a flow that was a departure from a traditional center.
What was the impact of these ideas?
We spent a lot of time studying how to help team efficiency and communication among providers, as well as between care teams. The bullpen cut down a lot of the actual walking for the team, and with everyone in the same room, it helped significantly with collaboration while lowering the various communication, handoff, and followup friction that often exists in poorly designed centers. In the member room, we designed a table for the laptop, and made it so the patient and doctor could share the screen side by side instead of on opposite sides of a table. Most of the design tweaks like this were done intentionally to enhance the member experience while also stripping out the threatening “institutional” feel of healthcare. We incorporated things like skylights and angled walls to increase the sense that this was designed to calm the patient and help them feel it was their space. And now, years later, I smile as I see the influence of the original designs (like our consult room desk and pocket doors) as they appear in other health centers as well. Again, these all seemed like little changes as we talk about them, but I was always surprised by how big the impact was from these subtle design improvements.
What was your experience during this time? What were you learning?
Well, what I loved about working with Crossover was that the team was extremely agile. They were also willing to explore new ideas, to try concepts and fail, and then to iterate and improve, and try again. I also loved that all of this was driven by the fundamental desire to truly deliver something different. It was great to be part of this team dynamic, put forward some of our best creative work, and have a client understand and be interested in the process as well as the outcome. Only later did I realize that one of Crossover’s core company values is “Design Everything.” When I learned that I smiled, because it was something that I was trying to express, and I could see that they were literally trying to live out their values. I liked that!
How did that standard get reused in future design work and where has it evolved today?
Crossover and Apple were both interested in creating an environment that felt uniquely on brand for Apple. So the Wellness Center was very white and clean, very much like an Apple store, and with the same elegance and efficiency you would expect there. We were really able to dial that in and based on the success and feedback I think we hit the mark with that unique client. For subsequent clients, we also chose to create unique environments that matched their ethos, culture, and brand. For example, the Facebook Health Center had a very specific look and feel (concrete, steel, and plywood) that was opposite of Apple. Other clients would take the core elements and add their own branding and unique features, twists, and interpretations to our original work. Finally, I felt like we were able to take all the lessons we had learned and apply them to Crossover Health’s own nearsite centers which they creatively controlled from the outset. This allowed us to really push the envelope and take the bullpen, member rooms, light boxes, and creative or artistic elements to the next level while also maintaining a repeatable standard that could be implemented throughout the country.
Please see link to Part 2 of this interview to see how the Crossover design standard has evolved and where he thinks it will go in the future.