Design Everything, Part 2—Architecture as an Experience Platform Foundation

Second in a series of interviews on the Crossover Design Standard. Part 1 of the interview can be found linked here.

In the last interview post with Howard Kwok, a senior architect at DES Architects and Engineers, he spoke about the beginnings of our relationship with his firm and his work on the original Apple Wellness Center. In this post, he talks about how his work continued to evolve with the company, the introduction of the nearsite project, and where architectural design may go in the future at Crossover Health.

What was different about the first nearsite project with Crossover at Shoreline? 

Unlike the Apple Wellness Center, or other onsite projects we had done with specific clients, this project had to be done fast, it had a much leaner budget, and it had to be Crossover’s “coming out party” for this new shared health center concept. So we looked at everything we had designed previously, and had to think through and explore how we could still deliver a great experience, but do so in much more efficient, smarter way, and at a different price point. The guiding parameter always remained that we could not sacrifice function nor experience, so that created a lot of “room” for creative problem-solving and no one’s favorite term, value engineering.

How did you value engineer a leaner, more efficient nearsite product?

One of the things we did was combine the exam and consult rooms. The amount of space the first designs used was a luxury that we didn’t have for this project, and I actually think the solution works much better now. One side of the room was focused on the exam, the other on the consult. We kept the round desk for the laptop because that worked really well, and maximized things like the closets (which we’re still working on, by the way), pocket cubbies for the diagnostic equipment, and finish details like lighting, laminates, and related details. We also worked on shrinking the size of the “show room” (there are no waiting rooms at Crossover), which resulted in a very modern look and feel with just a few chairs. As I step back and think about the efficiencies we were creating, most were really geared toward flexibility, so that as service demands, technology innovations, or other parameters changed, we could flex with those changes within the hard constraints of our physical space.

How have you seen the “Crossover Style” evolving over time? 

That’s an interesting one. Like I mentioned previously, we kept certain elements and principles as we designed the newer health centers—the bullpen, the dual exam/consult rooms, the showroom, and the combined gym space. While these elements always carried over between centers, it was never the plan to make them all look the same. We had in our mind to avoid being a chain restaurant—we wanted our standards there, but we never wanted it to feel like it was institutional. We were able to strike this balance through key design elements like skylights, the customer art, and affordable but elegant furniture, while maintaining the required professionalism by not making it too homey. The consistency comes from the actual member experience, not necessarily the physical space.

And we continued to work on making the spaces even more efficient. For instance, we realized that we didn’t need to keep all the supplies in the exam room, because it was so easy to centralize them in the bullpen and just bring in what we needed for each patient. And recently, Rich asked if we even need an exam table, which is big and a little threatening, so we’re looking at what’s called a recovery chair, which has the same functionality but looks much more like furniture.

Each center we design is becoming, I think, more open and less cluttered, even as we keep compressing the actual square footage. And even when we’re not the designers for some of the health centers, I still advise the team on how to keep the workflow and make everything more efficient, yet with the same experience. So although some of the design elements themselves are localized, I think there’s a common approach and experience that is really emblematic of their style. If I’m being honest, I have to say that when we aren’t the actual designers, some of the interpretations of our designs have not been successful. It’s not just seeing what it looks like upon execution, but actually understanding how it needs to function that is the key to great design.

What do you anticipate the future looks like in your work with Crossver? 

Well, of course, we’re always looking for new ways to improve the model. We want to improve every time, even with small things like the exam room closet and privacy area (Scott won’t allow standard healthcare curtains) and acoustics of the pocket sliding doors (which save a lot of space so we keep using them). We are attending shows, looking at new materials, and getting ideas from all kinds of places. I’m always asking about things we can remove without affecting the experience or functionality.

But we know Crossover is going through even bigger changes. Not only are they continuing to grow and scale as a company (more projects with bigger footprints) but their clients are starting to buy into the idea of virtual care. It has been quite interesting to explore the different ways in which providers can or should meet with remote patients—many times, people don’t even need to come in. A visit can be a bit of a waste of time and effort on all sides. Technology is going to change the mix—the back of the house will get bigger and the front of the house will get smaller as we reduce the need for people to come in and add more virtual consult rooms. I can see that we are going to have to make the spaces even more flexible, as people who do come in will see a lot of different specialists, rather than simply their primary care physician.

How do you anticipate merging the concepts of physical space with digital care delivery?

We’ve been talking a lot about how the visit will blur between the physical and virtual and how this merging can make collaboration even easier. Like everything with Crossover, we’re going to experiment. We envision better work environments, better audio and visual solutions, better collaboration tools and technology, and ways to ensure a strong care team environment when all the patients are remote. We see quite a bit of this evolving as we start piloting the technology this in the new year and expect to improve upon our initial virtual practices significantly over the next 12-18 months. Even if we’re not yet certain what the future health center will look like, we know it will look very different from the way they look today. But they’ll still be Crossover—easy, less stress, clean, and open.

Any particular favorite memory of working with Crossover Health that really stand out?

Nate Murray, one of Crossover’s founders asked me one time, “Why does DES want to support us?” It gave me pause to think about it both from my personal perspective as well as that of my company. In the end, where I landed was that Crossover doesn’t work within the traditional rules or even the traditional standards of design, they just work from how they think healthcare should be. They are focused on their goals and don’t really mind what is in the way—be it design, construction issues, timelines, or really anything else. The people are flexible, without the policies that slow down other health companies I’ve worked with, and everyone at Crossover is agile and willing to experiment. Most of all, the potential of Crossover to make a difference is very high. And we, like so many of their clients, want to be a part of helping to create what will be the new future health model.

Many thanks to both Howard Kwok for his personal friendship and professional skill, the leadership team at DES for their early foresight to be willing to invest in the partnership in the early days, and for Peter Heywood (one of our long-standing brand advisors and business consultants) who helped conduct these interviews.