S5 EP1: Stanton Kroenert on Mental Health

As Director at Skar, Stanton has been building healthcare across Australia for over 13 years, specialising in Private Health.

If you'd like to learn more about the AHDC, please connect with us on our website www.aushdc.org.au or on LinkedIn at linkedin.com/company/aushdc.

Transcript

David Cummins: G'day and welcome to the Australian Health Design Council podcast series, Health Design on the Go.

I'm your host David Cummins, and today we're speaking to Stanton Kroenert with a Masters' of Health Service Planning. Stanton has been planning, designing, researching, and building healthcare his whole career spanning over 27 years.

Stanton is a registered architect who lives for the world of health design. I'm excited to interview Stanton today to learn more about his view of mental health.

Welcome Stanton. Thank you for your time to be here.

Stanton Kroenert: Hi David. How are you going?

David Cummins: It's very interesting to say that you've spent your whole career working on healthcare.

I've interviewed a few people now and it's generally something people move towards and don't know about early on, or get sucked into later in their career and use basic health design or design principles to apply to health.

How did you get into the world of health design so early in your career?

Really easily, I was always hurting myself when I was younger and I'd just started my architecture degree and I was at uni and found myself in hospital which was very frequent. And I was lying there looking up at this dusty air conditioning grill above my head.

And I always thought, if I can ever have a say in how hospitals are designed, I'm never putting a dusty air conditioning grill above a patient's head ever again. So from that moment on, I decided I was designing hospitals. So that was how I got into it.

I love that.

But I would still argue, certainly in a lot of hospitals, I've been in the patient experience of going through a corridor where they still look at perforated ceiling tiles that have got water leaks and very, very dull design. I still don't think we've actually overcome that ceiling view for a patient lying in a bed have we?

Stanton Kroenert: And that's why I keep getting work, I think because I keep seeing it everywhere I go and it fascinates me. So yeah, it was that moment I decided, don't whinge about a problem, try and fix it.

So I've been trying to fix it ever since.

David Cummins: I love it. And the reason why I had to make sure I did say in your introduction is that you literally live for the world of health design, for those of you that don't know you, especially overseas, may I ask, how many times have you slept in your bed over the last 27 years based around your dedication to work.

Stanton Kroenert: Not a lot. I was homeless for quite a few years, just flying around doing projects. So yeah, it's been a fairly nomadic life, which I guess you can't really have a family when you live like this, but yeah, it's been very interesting and I think I've got about 15 years left, so I think it'll be an interesting 15 years.

David Cummins: I must admit, I did it for two years and became very, very single. But you do love the job and you love the projects and I think health is one of those things that, is so complex and so exciting that you can actually do so much and if we keep challenging each other and we keep identifying new problems, it's an an endless world of work that we can work with.

Stanton Kroenert: Yeah, and I think it's really sobering too, the thought that all of the most important things in your life happen to you typically in hospital. You're born in a hospital and most people die in hospitals. And the whole gamut of people... the first thing they see on this planet and the last thing they see on this planet are quite often something I designed well, that's really sobering and it does put into perspective what we do and how important it is.

David Cummins: I totally agree. So I remember very clearly a lot of people always say, oh, hospitals are a place that people die. My mum was quite sick at a younger age, and I always think hospitals are a place where people get better. So it's interesting to have that persona, but certainly when I was a kid, my mental health and my anxiety for being in a very strange, noisy clinical environment with a sick mom was quite scary.

So keeping in theme of mental health, how do you account for such an array of motions of excitement for a baby happiness, for someone getting better and people dying? How does one design for the mental health of not only the patient, the families, but the staff as well?

Stanton Kroenert: Yeah, so years ago I did a research project where I looked at the whole gamut of dying and being born and everything in between. And I was trying to work out what are the commonalities from a design perspective that you should look at in those kinds of thinking.

And what it came up with was, it needs to be familiar because one of the questions I asked patients who were literally within the last couple of days of their life and I got to interview 10 patients who were literally going to die within the next day or two.

And the question I asked them was (well, one of the questions was), "would you like to die here in this room you're in? And the rooms they were in were pretty average, but as a baseline point, it was a good point to start, or would you like to go home, and die at home?

And I thought everyone would say, I'd want to die at home. But I hadn't really thought that through because everyone answered "no" they wanted to die in hospital, but not one of them were happy with dying in the room they were in.

And the reason they didn't want to die at home was because they were scared, they might be in pain or there was also a stigma attached with "Auntie Jesse died in that room", therefore it becomes the dying room at home, there was some stigma attached.

So it was quite interesting that everyone that I spoke to preferred to die in hospital, but they didn't want to die in the room that they were in.

And so that got me thinking, and then the question I asked them was, what is it about your home that you like, that would maybe make it more comfortable if you had the other things that you got in hospital as well?

And the common thing was familiarity. So then I got thinking, the reason home feels familiar I think, is because you are used to it and you go there a lot and you're there for a period of time.

So I thought, well, why wouldn't you design a room that you could be born in and that you could go back to when you break your ankle for the first time, and then when you go to give birth, and you know when you are a parent, and then at the end stage of your life, to that same room.

Now, is there a way you could design a room that could do everything so that every time you go back to the room, at least the one thing that is common is it feels comfortable and you feel like you know what's going on?

And so that's where I got to, was trying to come up with a design for a room that would feel comfortable because you'd been there before and everything that you go to the hospital for makes it feel like it's familiar.

And we're not always talking about pictures of family or warm colours, how do you find that balance of respect and familiarity for someone in such a state?

Well, there's a few ways. Probably the best way is using technology.

So for example, you can have a room filled with screens now. Now there's nothing that stops you having the entire room filled with screens. You could put whatever you want on screens. So it could be pictures of family, it could be a live feed from your home, it could be a live feed from your dining table at home so you can have a meal with a family.

There's so much flexibility that using screens actually gives you in terms of how you can manipulate your own space or even a connection with the sky. So having a screen that's in the ceiling that potentially has a video camera on the roof of the hospital looking up at the sky, so you've got a connection with nature.

The use of technology in that respect can help but I also think that using AI will also help as well because as you become more incapacitated, AI could actually maybe predict what kind of images and what kind of feel will actually make you feel more comfortable in a particular physical state.

So I think that's where the future of that's going.

David Cummins: So just to clarify, you're talking about the technology just like the White Night or Vivid, where you can light up the Opera House or the Harbour Bridge where you can actually put those images throughout the room, correct?

Stanton Kroenert: No, I'm talking about physical, LED screens.

The cost of LED screens now is almost zero compared to what they were 20 years ago. And so filling a whole room with LED screens, and again, LED screens are pretty easy to clean as well, gives you the maximum flexibility in terms of the scenery that you are in, whether it be nature, whether it be your home, whether it be anything that makes you feel comfortable and familiar.

I think that would be a good use of technology.

David Cummins: It's a bit different from the small TV screens that hospitals are known for where traditionally, just like my mum, she just wanted to get out because she couldn't hear the TV and couldn't see the TV.

So that's taking it to next level isn't it, as a solution?

Stanton Kroenert: Yeah.

If you think about it in your last moments and you're lying in bed and you're looking up at this ceiling that hopefully doesn't have the dusty air conditioning grill, having a screen of some description where you could choose what you're looking at, I think is a nice way to, spend your last few moments.

I think that's really important.

David Cummins: How does one, again, related to mental health, help design for staff who are in a hospital for 12 plus hours a day or staff that sometimes don't have access to natural light, for families that are going through trauma and through joy, how does one create that safe, respectful environment with variants throughout the whole plethora of the hospital?

Stanton Kroenert: Yeah, with staff, you can look at retention rates as a pretty good measure of mental health in staff. So the places that have better retention rates typically have better staff facilities. So things like, places where they can go that are outside to be able to recharge, also not having stressed visitors and patients obviously helps staff be less stressed as well.

So anything that you can do, reduce stress, full stop will also help staff as well. The classic one is every time I go to a hospital I hear someone asking a staff member where they have to go to find something.

And to me that blows my mind in this day where everyone has a portable GPS, that we can't find our way around hospitals and we have to be constantly asking staff.

And it's just one of those things every time I see a staff member get asked by public... this is one thing they shouldn't have to do, but it's just part of being a staff member and every little thing like that adds stress, I'm sure.

Using technology, providing better staff facilities, they're obviously the things that are going to help staff mental health as well, especially reducing stress for visitors and patients will reduce stress on staff.

David Cummins: Yeah, I was going to say because it's already a stressful environment for people getting results or getting tests, so for them to get lost as well can add anxiety to people already in already a stressful environment.

What are some of the practical tips that we can use now? There's a lot of people listening who are designing, constructing patients who are entering these facilities and they've got certain pain points throughout the journey.

What is something that we can help do now for healthcare of the future? And what are some of the common themes that you've seen over your 30 odd years that we keep getting wrong?

Stanton Kroenert: As hospital architects, we're pretty good at designing spaces that work in terms of all the practical things.

I like the WHO's definition of health where they talk about "health isn't just the absence of disease, it's also physical, mental and social wellbeing". And I think that we have to focus not just on the physical wellbeing, but the mental and social wellbeing.

So at the moment, as I said, we're very good at designing spaces that are safe and you don't trip over things and you don't bash your head on things. So we're pretty good at that. But we haven't done very well at the other two sides, I don't think.

And when I look at the mental side of it and the social side of it, I also think of the spiritual side as well, because obviously, as I said, it's the place where you have your highest highs and your lowest lows.

And so I think looking at other sectors or other type of architecture that addresses those kinds of things is worth looking at. So things like churches, I think there are some lessons that you can take from churches. So for example when I grew up, and I got dragged along to church, and they had always a crying room.

Now crying room in a church was kind of a weird concept, but when you think about it was a room that the parents could take babies to, but they could still watch the service while it was going on. But it didn't disrupt everyone else because it was a soundproof room with a window that they could still watch what was going on.

But it was a really fascinating idea.

In hospitals, we don't have things like this because it's not seen with the same reverence. So I think there's other types of architectures we can take cues from to actually then, start treating rooms in the way that they should be.

David Cummins: Yeah, I totally agree and I do remember the crying room myself years and years ago.

Design innovation like that is fantastic and obviously served a purpose.

What are some design innovation techniques that architects can use today to help reduce anxiety for people entering facilities?

Stanton Kroenert: Wayfinding obviously is number one. That's not actually an architectural thing. Architects can show you the way, but I still think technology will be the thing that solves the problem.

As I said, everyone's got a GPS in their pocket and being able to get to wherever you need to in the hospital has to be as dumb as just following your phone. We've toyed with using, lights in ceilings or arrows in ceilings or things that light up to show you the way nothing works.

And I think using tech has to be the right way. Everyone carries a phone, so let's use that. So that's reducing stress in finding the way around hospitals. But my number one thing I think in patient bedrooms is make them quiet.

Now there's been this debate for years about, where you should place ensuites, whether they should be back to back or in board or whatever.

I can't even believe this is a debate anymore, but the number one thing is patients being able to sleep. And the number one way patients get their sleep interrupted is noise. So anything we can do to just make patient bedrooms quiet has the biggest impact on average length of stay.

So therefore putting ensuites in board to me makes perfect sense. That's one thing I would advocate for. But also, look back 30 or 20 years, and there was still a debate about single bedrooms, whether it's the right way to go. I think that's finished now.

Obviously, single bedrooms is the way to go for a whole variety of reasons. Using those principles just makes it a much nicer place.

David Cummins: And what about from a staff point of view, what are some of the design innovations we can do to improve their experience, to reduce their anxiety, to improve their work experience in the facility?

Stanton Kroenert: Being able to get outside to have your breaks tea rooms that aren't necessarily in a ward or a department so that when you take a break, you actually get out of the ward, and I know staff are very dedicated and they're reticent to actually leave a ward but you just have to, for your mental health, you have to get out, take a break, hopefully can get outside, but at least get away from the wards so you're not waiting for the bell to go ding.

I think that's gotta be number one.

David Cummins: And in reference to Healthcare of the Future, continuing with the conversation of AI, what do you think we need to start preparing for designing for, looking for, in this world of future health and the world of technology and AI?

Stanton Kroenert: So hospitals won't look anything like they do now. It's been interesting over the last really 70 or 80 years, hospitals haven't changed that much ever since the Nightingale Awards went away, still design them in a very similar way, but I think with AI and technology, they won't look anything like they do now.

For example, just a practical thing, I think medical wards will be a thing of the past. There's going to be a pill or an injection or something that's going to get rid of most diseases. And then I think there'll be much more focus on obviously emergency care, because that's worth humans.

We fall over and we break things. So you're still going to have a lot more emergency care, but I think that there's going to be a huge reduction in terms of in-patient type of medical patients. And so I think the focus should be on, not necessarily flexibility in design, because I don't think we can even design enough flexibility for this radical change that's coming.

But I think, thinking about what's coming and what's the best way to design it, because I don't think anyone knows yet and we better get pretty good at it pretty quick because otherwise all of us architects, we're going to lose our jobs to AI.

Some of the stuff I've been seeing recently that AI is doing, in terms of design is already got me scared, but fortunately hospitals are very complex, so I think we've got a while longer.

David Cummins: Yeah, I interviewed a futurist for our technology series and I questioned how scared should we be in the world of health. And as he said, "you'll always need someone to help you to go to the toilet, help you shower and things like that, and give you a hug". So it does have it's limit, especially the world of health.

Stanton Kroenert: I'm more thinking from a health architecture point of view. You'll always need nurses. Nurses are safe, us architects, maybe not so much.

David Cummins: Just before we go.

 You've had such an amazing career over the last 30 years predominantly in private health around Australia. Where do you think the next 15 to 20 years will be for yourself in the world of health design?

Stanton Kroenert: Actually, my background, before I started my own company was actually all public work. So I was actually doing big public hospitals.

And to be quite honest, I think that's where my future is because having an effect on large hospital projects, with all of the knowledge that I've dumped into my head, that's where I want to get back to and I think I've got something to contribute. So hopefully that happens.

David Cummins: Stanton, it's been absolutely pleasure to speak to you.

I have no doubt we'll be speaking a bit more in this world. Your company's 'SKAr' is absolutely phenomenal and well known around the world, especially with the world of health and private design.

Thank you so much for your dedication to this industry. To only sleep at your house a few nights a year is next level.

But certainly without people like you and your passion and design and desire to make sure that the patient experience is a better experience for all is a credit to you. So thank you so much for your dedication to this industry.

Stanton Kroenert: Thanks and good job on this podcast. It's pretty good. I like it. You have some really good stuff on here.

You have been listening to the Australian Health Design Council podcast series, Health Design on the Go. To learn more about the AHDC, please connect with us on our LinkedIn or website.

Thank you for listening.