S7 EP 3: Dr Emil Jonescu, Summer Series

 As the Head of Research and Development at Hames Sharley Emil explores the latest innovation and research for Intensive Care Units. 

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

[00:00:00] David Cummins: G'day and welcome to the AHDC podcast series, Health Design on the Go. I'm your host David Cummins, and today we are speaking to Dr Emil Jonescu who is a Doctor of Architecture, who specialises in Environmental and Specialist Psychology. This identifies the environment and how it shapes our behaviours.

[00:00:37] Emil works at Hames Sharley in the Perth office and has continued to utilise his research to assist better design outcomes for users. Emil has recently been studying the impact of acoustic treatment in the health setting, which I'm excited to learn more about today. 

[00:00:50] Welcome, Emil. Thank you for your time.

[00:00:52] Emil Jonescu: Thanks for having me. 

[00:00:54] David Cummins: So I understand your recent studies about acoustic treatment in the health setting and how that can improve patient outcomes. But what I really want to understand, before we get into that, is about your Doctorate of Architecture, which actually specialise in environmental and special psychology.

[00:01:11] I actually don't know what that means. So for those of us who are listening who don't understand what Environmental and Special Psychology is, do you mind explaining a bit more about your PhD and your research?

[00:01:21] Emil Jonescu: Yeah, for sure. 

[00:01:22] This area of study looks to understand how the space around us, the built environment, shapes our everyday behaviours. 

[00:01:30] It stems back many, many years and there are many studies and theories in this space. 

[00:01:36] One of the theories or principles that many people may have heard of stems back to Jeremy Bentham and the Panopticon. And that looked to shaping the way people behaved in a prison context through the application of architecture as a built form. 

[00:01:53] So the built form would inform the way people behaved by looking at the spatial articulation of the space. 

[00:02:01] What I mean by that is, the panopticon was a circular form with a central guard tower and all of the prisoners were on the external periphery, so they were lit up by windows around this circular form, and the guard tower in the center was darkened so they could never see the guard. 

[00:02:21] So they all had to assume that they were being watched all the time because they couldn't see if they were being watched or not. So what that tried to achieve was the prisoners would then modify their behaviour accordingly because they thought they were being watched all the time. 

[00:02:36] And then through that they would, once released, regulate their behaviour in society because they were . Constantly the thought that they're being watched. So in a that's the principle of how space can shape behaviour. 

[00:02:49] But space can certainly shape behaviour in more appropriate ways . Rather than in the prison context. And it's understanding how space can do that, that can allow us to design in much more appropriate ways, in different contexts and for different needs. 

[00:03:02] David Cummins: That sounds like it could be applied to any setting, whether it be university education, primary school, health, airport. So the principles of that theory can actually be applied to any industry, correct?

[00:03:14] Emil Jonescu: Yeah, absolutely. 

[00:03:15] That theory comes into place in any context. Certainly it didn't stay as a prison-only theory or principal in application.

[00:03:24] If you think about the way that a lecture theater is designed, for example, or a school classroom. They all use that same principle, which is in essence the balance of and relationship of power between the person and who they observe.

[00:03:39] It works in reverse as well, where if it's not a darkened center, everyone can also see the person that's presenting. But in essence, it's that relationship of power. 

[00:03:47] Obviously time has moved forward and we rely a lot more on things like different form of surveillance such as CCTV biometrics, et cetera.

[00:03:57] And these expand on those principles in a way that if it's not a visual presence of authority figure and person. A lot of people tend to forget about the CCTV et cetera. So that principle doesn't work in much the same way. It's that visual presence of authority or that spatial construct that's required to actually allow that principle to take place.

[00:04:20] So a lot of people that have written about this area suggest that if you have to rely on CCTV or other forms of surveillance then, design that tries to achieve that power is fundamentally flawed. Moving away from that, it's just an additional tool that can be used because obviously our technologies move forward so much. But you're quite right. It's a principle that can be applied. 

[00:04:42] Another area of study that I quite enjoy, which I refer to as tactical architecture, is understanding how it can shape behaviours in an anticipated way. 

[00:04:52] One of the things I like studying are things like urban furniture, and you can tell a lot about what behaviours are happening in a place based on the design of that urban furniture.

[00:05:03] I remember once when I presented a conference at Oxford. The urban benches, there were so uncomfortable that clearly it's suggesting we don't want people hanging around and loitering here. 

[00:05:14] It's comfortable maybe for five minutes till your bus comes. The handrails were such that you might see at airports, handrails are such that you can't lie down, you can't take residency so to speak. 

[00:05:25] So you can tell a lot about the sentiment and what's being said by understanding the urban environment in which you are. 

[00:05:31] David Cummins: Yeah. That's very interesting and I imagine being an architect, you would apply those principles almost to every project you work on basically.

[00:05:38] Would that be correct?

[00:05:39] Emil Jonescu: Yeah, absolutely. It's understanding that these behaviours happen, that there are behavioural norm. It's being cognisant of these things that allow you to address and design for as greater diversity of people that you can. There are other principles too which are by intent, not by accident.

[00:05:59] So if you're thinking about something like affordance theory. 

[00:06:02] Affordance theory being a sociology based theory that's about what the environment offers the animal. Us being animals in a built environment, the built environment offers us different ways of utilising and interpreting and using it.

[00:06:15] What I mean by that is if you have let's say a limestone retaining wall or similar, you can sit on it. It doesn't mean that it's an accident that people think to sit on it, it's been sized appropriately so someone can sit on it.

[00:06:30] if you think about a milk crate, for example. It holds milk bottles, but it can also be used to create book storage out of, or it could be used to carry things.

[00:06:38] So it's about what people's interpretation of that object or place could be that allows them to afford it for something else. And some of these things can be intended or unintended, there can be some happy accidents that come out of it, because people obviously interpret spaces differently. 

[00:06:53] The example of that would be the way somebody that's interested in parkour as an activity reads and interprets the spaces and objects in the built environment in a different way to what was potentially intended. 

[00:07:08] However, there are many designers out there that understand that this is an activity that the urban environment invites and are working with that rather than trying to work against it. 

[00:07:19] Similar with skateboarding as well. You can work against it or you can work with it and build it in such a way, or design in such a way that it is an activation tool. It's a place making tool. So I think designers, also our clients that we work with and learn together with, understand that these are place making opportunities rather than shunning these activities to somewhere else. 

[00:07:44] David Cummins: And do you think that since Covid, that need for urban design and urban planning and a more structured outdoor environment or more flexible outdoor environment, do you think Covid has actually changed the way people see that?

[00:07:54] Or it's always just gonna be open to interpretation from users?

[00:07:58] Emil Jonescu: I think that Covid definitely provided researchers and designers with a different lens through which to understand how space can be designed and ordered in such a way that it allows that flexibility. We don't know what's gonna be around the corner. It could be worse, it may not.

[00:08:16] Some of the other studies that we've looked at with ECU are looking at speculative futures, which can be things like.. There are three or five pandemics all happening concurrently in say 50 to 70 years, et cetera, et cetera.. 

[00:08:30] We don't know, but what we do know is that we need to be more flexible in how we design spaces to accommodate for unforeseens like this.

[00:08:38] David Cummins: Yeah, I agree. And flexibility in our podcast series seems to be a very common theme, especially in healthcare where what traditionally was built 40, 50 years ago for one purpose, one room. 

[00:08:48] The word flexibility seems to be quite common throughout all our podcasts where people are designing for the unexpected these days.

[00:08:56] Yeah, absolutely. I think that flexibility provides for those unknowns. As I was talking about affordance, you can design to what others know that you might not. 

[00:09:05] Allows them to interpret the space in a different way equally the unknown trend in the future, we can't design for now, but we can be clever enough to allow sufficient flexibility that it could be adapted.

[00:09:18] Yeah, absolutely. And sticking with the theme of health. At the moment I know you're doing some research with ICU in a few different hospitals. I find this research very interesting and very exciting. 

[00:09:29] Do you mind just telling a few people who aren't aware of your research into this field exactly what you're doing at the moment and how it can improve patient care?

[00:09:36] Emil Jonescu: Thanks for that question.

[00:09:37] It's actually really interesting to me too as my background is not in healthcare research, so I'll caveat this, but the role that I play at Hames Sharley is about understanding the gaps and putting research teams together to try to get to the bottom of these. 

[00:09:53] Form bespoke methodologies if required or hybrid methodologies.

[00:09:57] Predominantly from a, what you'd call a communities of practice perspective, which means that we have a number of different groups of people that form an ecosystem and we need to exchange knowledges and ideas through design thinking to allow us to probe some of these wicked problems that are difficult to solve just by one entity alone.

[00:10:20] I was introduced to an Intensivist at Fiona Stanley Hospital, and we got to talking and he has done a lot of research himself on trying to mitigate the effects of noise on patients in an ICU context.

[00:10:35] Patients that would require the most amount of rest but are likely to receive the least because of the noise factor in ICU rooms.

[00:10:45] And we got to talking about, well, can we try to do something together through design? So there's been a number of initiatives that he's tried in understanding the types of noises and using ear plugs and whatnot. And our approach was, well, can we better understand the signatures of the sounds that are happening in that space.

[00:11:07] So in essence, we've done a signature study on each of the different noise generating pieces of equipment in the ICU room to understand its frequency volume et cetera. And also we've taken the opportunity to embed an acoustic microphone to record over a period of two weeks, the level of sound level of noise.

[00:11:31] We've also placed a lux meter to understand the way the light is behaving and also a thermal data lager as well. So I've got these three different pieces of data that are coming through and we're looking to understand. Also the occupancy in the room at that time, and what sounds are happening at that time.

[00:11:54] So in essence, there are times when there is no one in the room, but it's more so when there is an occupant in the room that we want to understand what is the level of noise and what's the likely equipment that it's coming from. 

[00:12:10] If we're able to understand, we're able to understand better, is the level of noise in line with the World Health Organisation requirements, if not, then we take a spatial modeling approach where we tried different versions of that room with different specifications to see if we could then have the acoustic consultant calculate what would the likely outcome be. 

[00:12:34] It could lead to potential for product design through a phase two where we work with makers of some of the equipment finishers in the room.

[00:12:45] But also then it allows the research outcomes costed as well. We're looking at working with a quantity surveyor as part of this ecosystem, and they will do a a full take-off of this new model that we're proposing that might reduce or mitigate the level of noise so we can understand put some quantums and understand, well, what does that actually mean.

[00:13:07] And could we potentially go for a phase two where we look to fit out a room like this. And then test it in real life rather than just based on quantums that we gather. 

[00:13:19] David Cummins: It's quite a wicked problem as you put it, because at the end of the day, those noises are there for the nurses to care for the ICU.

[00:13:27] The ICU patients are the most sick patients in the hospital who actually need the one to one care. 

[00:13:33] It's a balancing act, isn't it? Because you've got the most sick and most vulnerable who need the most care, and those noises are there to alert the carers about something that is or is not going correct.

[00:13:46] So it's a very interesting challenge you've got there. So how do you account for clinical side of it with the nurses and the doctors that need to be there and need to be alerted to those needs of the patient?

[00:13:56] Emil Jonescu: Yeah, a hundred per cent. 

[00:13:57] We have that quantitative pings and data and graphs that we can understand what's happening from what our data logs pick up. One of the other methodologies is we have a survey instrument that the health professionals that come into that are currently undertaking. And that asks them their level of experience, what noises they define as a noise, what's a really irritating noise and what sounds they need to actually hear. 

[00:14:24] Trying to discern the difference between the two but also as part of the signature study that I mentioned earlier we tested the decibel output at mid-range and high range.

[00:14:36] So again that's one of the limitations, but a future study could look at testing at an individual level, what decibel level of the machine is sufficient as opposed to what it's set at. 

[00:14:47] We noticed that some of the equipment had easy and ready access to changing the volume, whereas others did not.

[00:14:54] So it's understanding well, is it loud enough that it can be heard? Does it need to be louder or is it just set at its loudest because everyone keeps turning it up and down. 

[00:15:05] That's another really interesting point and that is also gonna be predicated on the individual person's hearing capability as well.

[00:15:12] But it's a very, very interesting question and certainly one that we're beginning to try to understand through the survey. But then a more of a physical capability type study could follow as well. 

[00:15:23] David Cummins: Sorry for all the hard questions, but I do find the topic interesting. Is there actual research to show that an ICU patient most likely in a coma is not getting the rest they need because of those noises?

[00:15:37] Is there actual data to say, well, he's in a coma, she's in a coma, but those noises are delaying the healing?

[00:15:48] Emil Jonescu: That's not layer of expertise. 

[00:15:50] My understanding is that there definitely is research in that field. It's probably a question that's better fielded by my learned colleague that's part of the study from a clinical perspective. He has looked at that and there is studies out there, but I couldn't cite it for you.

[00:16:06] That's all right. 

[00:16:06] David Cummins: I think I've worked out my next podcast, so we will get in the ICU physician and we'll go from that for the next podcast, but it is very interesting. 

[00:16:16] The other thing that I'm thinking as well is, I know you're talking about stage two for your research, but what type of acoustic treatment are you thinking?

[00:16:23] Is it something as simple as acoustic perforated ceiling? Is it as simple as carpeted walls? What actually is some of the things that you are thinking about at the moment?

[00:16:37] Emil Jonescu: Certainly some of my thinking at the moment, it needs to be considerate of what is not gonna impact on the needs of having homogenous surfaces so there's no infection issues and things like this. So my approach is more around potentially modifying the existing materials that are there to allow them to continue to be homogenous, however, potentially not so smooth reflective, et cetera.

[00:17:08] I mean, just putting it out there might be that from the spatial perspective why is it that the room has to have 90 degree corners? Would it not behave differently if they were made obtuse? And the answer is yes, but we don't know how much and whether it's feasible or worth doing.

[00:17:25] But if we model this through a study like this, we obviously don't want to trial this on a live build. So studies like this really allow us to design-think and ideate outside the box and then reign it into what is actually feasible to do. 

[00:17:39] My thinking is probably floor and wall, it needs to be homogenous, but if you think about a golf ball, it's a homogenous surface, but the dimples allow it to perform in a different way. So could it be something like that? 

[00:17:53] Could it be ribbed in a certain way? Still able to be cleaned, doesn't allow for transference of bacteria, et cetera. It can still be cleaned off but may perform in a different way because of the, the surface of it. 

[00:18:05] David Cummins: Yeah. And you mentioned flooring before ob obviously if anyone's ever been to an ICU, it is a cold, very clinical environment, which probably hasn't been challenged for years. People are using more colours now and using more partitions and using more pendants, but that flooring option, obviously, because there's a lot more bodily fluids (of blood and vomit and so forth) it's a very hard thing to challenge in such a specialist and clinical environment.

[00:18:30] So I'd be really interested to see what you thoughts are in flooring. 

[00:18:36] Emil Jonescu: Yeah. Completely. 

[00:18:37] Flooring is absolutely critical. You're a hundred percent correct. In terms of also the surface area of what we see, it also forms a huge component of that. I know that there's research out there that stems back quite a number of years, and I guess manufacturers of homogenous surfaces such as what one would find in a hospital, were looking to explore what else can be done or how else can the flooring be used. 

[00:19:03] And I know there's research out there about using flooring for wayfinding embedding QR coding into it embedding stories into it. So there's a lot of research in that space.

[00:19:13] In the hospital context, I wouldn't say it's untapped, but I think there would be quite a great deal of potential for looking at that flooring space as an area of significant opportunity. 

[00:19:24] David Cummins: I know there's some rehabilitation centers, especially stroke centers that have changed and challenged the flooring protocol for acute stroke victims where it's more cushion flooring because there's a high chance of them falling and breaking their hips. 

[00:19:37] So I imagine if they've got that in rehabilitation, what a cushion flooring would do in an acute setting, especially knowing that it would have some form of acoustic treatment.

[00:19:51] Emil Jonescu: Yeah. You raise a really interesting point, and I guess it's potentially testing what is the transferability of the use of it in that space, and its acceptance in a different space, whether that works towards ameliorating sound transference as well. 

[00:20:08] I guess the other opportunity of research such as this is it could help inform the Australian Health Guidelines as to what performance outcomes are achievable with some real hard data and I guess scientific rigor behind it. 

[00:20:22] Personally, I see this as potentially supporting things like the facility guidelines. With some different ways of approaching, thinking about how you could still being keeping with the requirements but through different materials, material science and other forms of research as well.

[00:20:38] David Cummins: Cool. So what would be the next steps in your research? I know you've talked about a different phase, but where would you like to see this research go eventually?

[00:20:45] Emil Jonescu: I'd love for this research, once complete if we are able to demonstrate that noise can be attenuated to degree, what is that degree, and what is it that we did to be able to publish this research? 

[00:20:58] The contributors in that ecosystem (so obviously you have the design, you have the acoustics, you have the quantities, you have the clinical) has their own takeaway from that as to what is a key value add to my area of knowledge.

[00:21:12] So we can all co-contribute together or in our own practices in what we do and write to some of the learning and outcomes of this. 

[00:21:21] My hope would be is that it builds on the body of knowledge and that there is more appetite for this collaborative type of research that doesn't just sit within a fee-based project where the knowledge is encapsulated as part of that project.

[00:21:35] Trying to solve some of these wicked problems really needs this more open platform of research. My hope is there would be a phase two and potentially a whole lot more discourse around the outcomes of the study and, and the where to next and who else could we work with to solve the next problem around the corner.

[00:21:52] David Cummins: Yeah, it's very interesting. I must admit my knowledge in this space is quite limited. So I appreciate everything you've said today, but is there any actual such research in this field overseas at all?

[00:22:01] Emil Jonescu: I know that there is research in attenuating noise in healthcare spaces. I'm not sure if this methodology that we're applying in this type of space has been done to be honest, not in the way that it's occupied room in a single occupancy space for the period that we are doing it and using the ecosystem that we have.

[00:22:23] So I really hope that it contributes to that body of knowledge and equally to the clinicians that are involved and even expand the circle of of who they usually might involve in the research. I know that a lot of research and, and architects and designers are no different.

[00:22:39] There's safety in researching in your own field and then publishing in an area with like-minded people that understand. It's quite different to (although it's growing) that interdisciplinary research space where you have very dissimilar approaches but to a common problem.

[00:22:58] For me, that's where the new learning comes in and is of value. 

[00:23:02] David Cummins: Yeah, I agree. I just wanted to say thank you so much for all your research today, especially in your field of health and acoustic treatment. 

[00:23:10] It's certainly people like you and your team that actually help provide better clinical outcomes for patients, which certainly if we don't keep on having research to support our theories it certainly would be stuck where it was for quite a while.

[00:23:21] We do appreciate all your time and effort into this field, into all your research so far as well. 

[00:23:25] Emil Jonescu: That's very nice of you to say. Thank you very much for the opportunity. 

[00:23:28] David Cummins: Thank you, Amil. Thank you for your time. 

[00:23:31] You have been listening to the Australian Health Design Council podcast series, Health Design on the Go.

[00:23:37] If you would like to learn more about the AHDC, please connect with us on our website or LinkedIn. 

[00:23:42] Thank you for listening.