because CHANGE HAPPENS.....


"Every organization is perfectly designed to produce the outcomes currently being produced”. This idea and its corollary, “To change an organization's outcomes, we must change its design” are the terra firma upon which our dialogue rests. __ Dialogue on Design, Nov. 2014"

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"Designing for quality at every level of performance and experience suggests that expertise must be connected peer-to-peer and design processes run parallel, concurrent, connected with each other and with users…leading to adaptive capacity in the architecture which can face future change with less upheaval." __Dialogue on Design, Feb. 2015

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"With a new practice of healthcare architecture designed to be “highly iterative, concurrent design, parallel, connected and widely user participative might we approach more closely what Cliff calls “a Quality design … aligned to a purpose through all levels of a system?" __Dialogue on Design, Feb. 2015

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Zone of Collaboration

  I got to know and work with some amazing people in 2014; friends, colleagues, collaborators, and clients. People dedicated to exploring new ideas and new ways of applying old ideas, to improve how we live and work together. So here’s my 2015 wish for you: Find some fellow explorers. Look outside your ‘silos’. Go […]

Population Health – Engaging Al...

Two of our current projects are defining new models for delivering health care to under-served populations in Harris County, Texas.  Both involve creating new access to health services through neighborhood ‘portals’ – places where communities gather already.  Introducing health services into a community gathering place brings lots of change: new service providers, new ‘customers’, sharing of […]

Healthy Communities Design

I had the pleasure of participating in a “Healthy Communities Design Workshop” in the Gulfton neighborhood of Houston a couple of weeks ago.  Hosted by the City of Houston, Health and Human Services department and the Asakura Robinson Company, it’s part of a multi-neighborhood project to increase awareness and get community input on “Health and […]

Community Health Centers

Changes in health care policy, and a dynamic marketplace that’s looking to improve quality and reduce costs, may put community health centers in an exciting position to be innovators in the movement toward a health care system that is focused on pro-active population health. Community health centers are at the tip of the spear of […]

Research & Development

As an architect I’ve always been envious of the car designers and their ability to indulge in endless R&D with prototypes and test labs, refining their cool designs and pushing the limits of performance. Finally, today we are beginning to realize the dream of R&D for architects.. with Architectural Prototyping becoming an established form of […]


As I’ve read through the stream of e-mails and news alerts this week, there is no shortage of strategies and advice about what Health Care in America needs in the coming year – or the next five years. While a lot has become clearer in the past two months about evolving policies and markets, the […]

A Balancing Act

Achieving “Performance, Form, and Flow” is not easy.  Delivering health care that is cost-effective, high quality, with a satisfying experience for the patient takes thoughtful planning and design of Care Delivery, Health IT systems, and Physical Space.  Most importantly it requires knowledge of the interrelationships between these three domains, and a complex ‘balancing act’ to […]

Performance, Form and Flow

In his “10 Books on Architecture” in the First Century A.D., the Roman architect Vitruvius gave us the formula for good architecture – “Firmness, Commodity, and Delight” – a formula still respected today, it has served us well.  But I’d like to humbly propose a new formula for our complex buildings of the 21st century, especially our […]

At The Intersection

This was originally published as a “Guest Blog Post” at on April 9, 2012 Posted by Ron Smith, President/CEO, design at the intersection, LLC I just watched a wonderful video about an innovative Operating Suite at Bruges Saint John General Hospital that uses an “open theater landscape” concept.  In the intro to the video, […]