Applying lessons and principles from an architecture education in a public health context.

It was the fall of my senior year, and the big question was: Architecture or Law? I was considering architecture school or a liberal arts education on my way to a law degree. I talked to architects and lawyers, made lists of pros and cons, and met with my high school teachers and guidance counselors to gain insight that might help me decide. One mentor I consulted asked me: “Why Law? Why Architecture?” The answers were telling.

I was considering architecture because my grandfather was an architect. I loved art, math and physics. I was interested in how things worked. Those seemed like solid reasons to choose a career in design. Then I thought about why I was considering law. I enjoyed constructing the building blocks of an argument, but I didn’t really like research papers. I had visited a law school once and I was struck by the building. It had impressive expanses of marble and granite, thirty inch high letters spelling out “School of Law” etched in stone, stately wood paneled court rooms and contrasting cozy meeting spaces. It was an amazing facility. In fact, I was considering law because of that building. After this realization, I decided that architecture was the path that held value for me. It was architecture that was influencing my career choice, and I understood then that the power of the physical environment shapes lives.

Now, almost 30 years later, am I shaping lives with the value of that education? As the Chief Sustainability Officer for the Centers for Disease Control and Prevention, I lead our agency to change our culture, streamline our operations and improve our physical environment. While this is not a typical design field, I use the lessons of design school in my daily work. My office seeks to protect the health of our people, the resources of our planet and the taxpayer dollars in our pocketbook. I learned about the principles of sustainability while in architecture school. We studied energy efficiency, brown-field redevelopment, the form of the city as a societal catalyst and the influence of the physical environment on public health. But there are other, broader lessons that are a part of the design education and are completely transferrable to many fields of practice. I build daily on these lessons — communication, collaboration, rigor and design thinking — in the work I do for CDC.

For example, in 2009, a federal mandate came down establishing eight goals for sustainability within our agency. The mandate establishes reductions for energy use, water use, greenhouse gas production, waste, data-centers and fleet fuel use. Guidelines are in place for the types of office products that can be purchased, the ways we can use our potable water, and the features that our new buildings must incorporate in their design. The mandate is fairly short but has far reaching, complex implications for almost every person working for or with our agency. My job is to create awareness of these requirements and move the agency towards the targets for each and every area of the mandate.

A key part of any architecture education is learning the skills of translating complex technical information into an easy to understand format that moves the audience to act. Understanding what motivates various stakeholders and presenting ideas in a way that they can understand, get behind and champion is key. You need to know how to present the information visually, verbally and experientially so that people are engaged. I work with communicators and subject matter experts across the agency to present our sustainability goals in ways that help people make the right choices and support the overarching targets in their daily work life.

One example is the mandate to move from virgin paper to recycled paper. Prior to 2008, less than 10 percent of CDC paper purchasers were buying recycled paper. The mandate requires that all paper be 30 percent post-consumer-fiber, at a minimum. To facilitate this change, my team and I first identified all the concerns that could prevent action by the stakeholders. We tried to understand the problem completely, just as you would a design project. We surveyed paper users and listened to their concerns, which included worries about paper jams in copiers, fear that the paper was more expensive than virgin paper and concern that the paper would look dirty and not as professional as virgin paper. Then we looked for precedents, locating other agencies with a track record of using recycled paper, and we documented their results. We researched the costs and outlined actual cost savings when coupling the new paper with our double-sided printing initiative. We identified high use customers and asked them to pilot the new paper, painstakingly recording their success with the product. We constructed a one page document that addressed each of the concerns and presented it to leadership. We, of course, printed it on 100 percent recycled content paper and had virgin paper available to demonstrate, in model form, how the two compared.

While the mandate asked for 30 percent recycled paper, we were able to convince leadership to adopt a more ambitious goal based on the positive health effects of selecting 100 percent recycled paper over the 30 percent version. By knowing our audience and connecting our goals with theirs, we were able to increase their commitment above and beyond the mandated minimum. Visual, written and verbal communication skills learned and honed in design school made this project a success. Design education prompted me to consider not only the message but also how we presented and supported that message to demonstrate the value of this effort to the stakeholders who would carry out the implementation of the plan.

In my work, I am responsible for an overarching initiative for CDC that we call “Go Green, Get Healthy.” We marry the environmental sustainability efforts of the agency with the personal health promotion activities of our people. We find that by pairing the environment with human health and also throwing in fiduciary responsibility, we broaden the appeal of the message of stewardship.

One effort that demonstrates this linkage clearly is our goal to make our food service operations healthier and more sustainable. Early on, we determined that there was great room for improvement through research, site observations, data evaluation and study. Understanding the problem required research into the regulations that govern federal food service. Food service and concessions are reserved by law for persons who are blind. Many times these vendors are not highly-trained, professional food service operators, and they usually do not have specialized expertise in nutrition, sustainability, or marketing and promoting health or sustainability. We set up meetings with our own vendors to understand their unique perspective and the challenges that they face. This led us to design and develop tools for our vendors that would help them select healthier choices but would still fit in the supply chain model that they are accustomed to using. We did not develop these tools in a vacuum. We recognized that we are not the experts either.

Leaning on my understanding of the role of the architect as the coordinator and facilitator of many subject matter experts in the planning and construction of a building, I brought together experts on nutrition, heart disease, physical activity and obesity, food-service operations, federal procurement regulations, energy use, water use, facility design, and marketing/choice architecture. Together, we developed a set of guidelines and tools for food service operations that gave vendors goals to aim for and plain language directions for implementation. We were rigorous in our approach. We looked for science that supported the recommendations and guidelines. We shared the process with the larger rings of stakeholders to keep them involved and help identify problem areas early when we still had time to adjust the design. Once we gained solid buy-in from our own organization, we broadened our discussion and included other federal partners like EPA, GSA, FDA, HHS and USDA. We looked for connections with their efforts and worked to build a cross-agency work group to develop a guideline for the whole federal government.

The rigor of our exploration and clarity of our model helped others buy-in and adopt the system. Many states and other food service systems have adopted the guidelines in their own contexts. These larger efforts strengthened our own initiative, and we have been able to make progress year by year to provide healthier, more sustainable food service offerings in our facilities. Design education focuses on knowing something about a lot of different things and facilitating the collaboration of subject matter experts towards a common goal. Our food service, and that of the nation, has been improved by these collaborative efforts.

In the case of food service, a top down approach was needed to engage the stakeholders and establish a coherent policy solution to the problem of delivering healthy, sustainability concessions. Many of the problems of operations can be changed with a smaller group of staff working towards sustainable solutions. To help promote this kind of grass-roots action, I developed a framework for talking about implementation of sustainability within CDC. The framework is called TRAIL, which stands for Think, Research, Act, Integrate, Lead. The idea is to give individuals and small groups a way to move their own improvement projects forward.

The first step in the TRAIL framework is to Think about your process and imagine that it could be different or evolved from the way it is currently. A couple of years ago, I had a business process owner share that she had begun thinking about a yearly HR review that her office conducts. She wanted to become more efficient, save money, reduce stress on staff and minimize the amount of paper used during the process. I encouraged her to take the next step and Research alternative ways of achieving the end goals of her process with a new more-efficient process. She researched several alternatives and decided to use a web collaboration tool to share the information that was previously printed, copied and circulated. Once they identified this preferred option, they Acted by implementing the new tool and evaluating the results. Timelines for staff review became more generous as the print time was decreased. Stress on staff was reduced since they were no longer carrying around hundreds of files for the review. Paper use and the associated costs of printing and delivery were almost completely eliminated. At the end of a successful trial, they Integrated the approach into their standard operating procedures and they identified other systems where they could use the tools for similar results.

The Lead phase includes broad leadership activities such as writing up best practices to inspire and educate other business units, submitting projects for awards and recognition, coaching others to make similar changes, or taking on another related project to stretch their commitment and understanding of sustainability. This business owner presented the results of their sustainability project to the leadership board for CDC and also wrote up their experiences for our internal electronic website. The initiative became a model for other efforts, and the project lead is known for her leadership in this area. By providing a framework for design and implementation, I have been able to leverage the time and efforts of leaders across the organization to make changes to our operations and move towards our collective targets. Design education is bringing out lasting value again.

Collaboration, rigor, design thinking and communication are building blocks of design education. When I chose my program of study in Architecture, I did so because I wanted to make a difference for people in their everyday lives. I envisioned the built environment as the way to make that difference when I was selecting my degree field. It might have been valuable at that time, if I had known more about other fields such as sustainability, public health and business process improvement, that have similar goals and build on the same skills and approaches as architecture. The role of an architect is to collaborate across various silos and translate differing needs into a unified, actionable vision. What I have done in my career is utilize that role to improve the policy and cultural environment, in addition to the built environment to improve health, wellbeing and sustainability. As an architect, the skills I have learned bring value to my position as an operational consultant and leader for CDC.

Liz York is the Chief Sustainability Officer for the Centers for Disease Control and Prevention. She is a registered architect and earned a Masters of Architecture and a Bachelors of Science in Architecture from the Georgia Institute of Technology.