Nurses Spotlight: Debbie Gregory, RN, BSN Bridging the Gap Between Design & Function

We at Fitsi love design almost as much as we love nurses. So who better to interview than Debbie Gregory, a nurse who also holds a degree in interior design! Based on her 30 years of experience as a nurse, healthcare consultant, and interior designer, Debbie is an industry leading advocate for clinical representation to build functional healthcare environments that improve safety, efficiency, and patient outcomes.

Debbie co-founded the Nursing Institute for Healthcare Design, which has grown to more than 100 members, and is the Senior Clinical Consultant at Smith Seckman Reid, Inc. She is currently working on a Doctorate of Nursing Practice at the University of Minnesota and is an adjunct professor at Vanderbilt University ’s School of Nursing.

Debbie has published numerous articles regarding healthcare design that have appeared in the American Journal of Nursing, Academy of Medical Surgical Nurses Nursing Matters, IIDA Perspective Magazine, Healthcare Design Magazine, Medical Construction and Design, and Nursing Management. She is also frequent speaker at healthcare design related trade shows and conferences.

We interview Debbie on design in the healthcare space as well as challenges designers have in the medical community.

1. As an RN, what motivated you to pursue design?

After over twenty years as a nurse, I decided to go back to interior design school. At that time there was no connection between design and healthcare in my mind. I had the unique experience of completing my interior design internship at a large healthcare architectural firm. The architectural firm was interested in the nurse’s perspective on designing the healthcare environment and sought my input on several levels. The experience influenced my current perspective in two ways. First, the architects did not really understand the culture and role of the clinician and how design impacts workflow. The architects were designing a labor and delivery suite and wanted my input as a clinician as to where to put the baby bassinet. I began asking questions as to how many deliveries does this facility generate per year? What region of the country is this hospital? What is the care delivery model for this unit? What is the average age of the clinician on that unit? The architects knew none of the information to these vital questions.

There needs to be a strategic bridge of collaboration, education, and communication built at the national level to effectively make a difference at the design table.

Second, I was invited to the table with a group of clinicians, architects and designers. The architects were talking about the ADA Guidelines as the nurses sat in confusion. I sensed the impasse and held up a time-out sign. I assessed the level of understanding on both sides and realized the nurses thought they were talking about the ADA diet. Through both of these situations, I realized that the nurse needs an advocate and interpreter to bridge the gap between design and function. There needs to be a strategic bridge of collaboration, education, and communication built at the national level to effectively make a difference at the design table. I began doing research on healthcare design and assessed that there was a large gap.

2. What are some barriers to good design in healthcare spaces?

Building a new facility is an overwhelming task. The consistency throughout the process (4-5 years) is immensely important to understand what drives the design decisions. Keeping the mission statement and design intent at the foreground of every discussion is ideal. Hence, one barrier is staff and leadership turnover. The most successful projects are those that have a vision and consistent team throughout the project. Competing budgetary priorities are often a barrier as well. Many times one person’s priorities overshadow or trump another’s and that person leaves before the project is finished. A project should never be built around one person’s preferences or priorities. The planning should be based on a corporate goal and mission. This complex building process has many moving parts. Lack of experience or education on the design and construction process can lead to poor decision making and create timeline and budgetary issues.

3. How might the importance of design be better communicated to the medical community?

I will speak to our nursing community and national organizations. It would be wonderful if our national nursing leadership considered this a competency for nurse executives. An educational focus for nurse executives and nursing schools would be valuable. Some nursing schools have taken this on and many nurses are interested in pursuing this as their specialty. One way to participate is to include a focus on healthcare design as part of the Magnet Status. We have been able to get a “Clinical Track” with continuing education credits at the Healthcare Design Conference. This is a giant step to sharing knowledge and providing a place for nurses to learn and collaborate. On a national level, there are so many competing priorities – it is a difficult task. Healthcare design nurses writing articles and speaking is one way to disseminate the information. The Critical Care Quarterly Journal has created several issues focused on the design of critical care spaces. I have been able to bring many experts to the table as the guest editors provide expertise in that specialty area.

4. What inspired you to create the Nursing Institute for Healthcare Design? How does your organization want to change healthcare design?

My initial experience began as a research effort regarding healthcare design and determining how nurses can contribute as part of the design team. At a Healthcare Design Conference in 2005, I slipped a note to a speaker asking him to announce an impromptu meeting for nurses in the audience. From those 10 nurses who showed up and responded to a quick survey created on the spot, the database of nurses in healthcare design was born. The conference began the challenge of discovery to determine where the nurse fits in to the design process and what role the nurse should contribute as a part of the design team. These nurses at the conference did not realize that other nurses existed that are interested in healthcare design. Each one thought they were alone with no colleagues or resources. The Nursing Institute for Healthcare Design was born out of this need. A 501C6 was established with the mission: to promote health care design standards, promote inclusion of nurses in health care design, provide educational programs for its members, and disseminate new ideas for all areas of health care design. Today, the Nursing Institute for Healthcare Design has over 100 members. There are even some international members. We have just reworked our mission and vision statements – NIHD Mission: To engage and integrate clinical expertise and planning into the design of healthcare environments. NIHD Vision: Shaping the future of healthcare environments through clinical and interprofessional leadership. It would be our dream to have a clinical voice on the design team of every healthcare design project with a vast resource of best practices, evidence based design and education to help nurses understand how design impacts their care delivery.

Healthcare design will be more about keeping people “out” of the hospital.

5. What does the future look like for healthcare design? What is most exciting? Most challenging?

The future for healthcare design will look very different. Large hospitals will not be the focus. Healthcare design will be more about keeping people “out” of the hospital. Outpatient settings, consumer driven health, telehealth, mobile health and health system consolidation are on the horizon. Creating a new healthcare delivery system that involves the patients and families and provides access and ease of care is on the design table today. The exciting piece: Many health systems are incorporating innovation centers within their facilities where staff come together to help design better care. It is exciting to see interprofessional staff empowered and taught “design thinking” skills to create and innovate for the future. The challenge continues to be the cost of healthcare and patient’s taking ownership of their health journey. It is an exciting time in healthcare today, innovation and transformation are on the way.

6. What questions do you think we should be asking more when designing for healthcare spaces?

The design of healthcare spaces should always have the patient at the center of the design. The nursing perspective should then drive the workflow and design discussions. Many times old broken processes are taken into beautiful brand new buildings. These workflow discussions should be happening years before the drawings are ever even discussed. Another important piece is interprofessional collaboration. Healthcare delivery involves a lot of people. An important question to ask, is “Who else should be at the table and involved in the discussion?” Other integral departments are lab, pharmacy, respiratory and many others. Another question that is often not considered, “What is the current nursing model?”. Many decisions are made in the design process that affect how care is delivered. Connecting these two during planning can help the staff understand how their care delivery model might change. This is just the tip of the iceberg. Having a clinical ear and voice at the table will help guide the discussions – nurses intuitively know what questions to ask.

For more information on the Nursing Institute for Healthcare Design visit