You won't find Sanford Smith's name on the roster of doctors at Hoag Hospital Presbyterian in Irvine. He doesn't dispense medication at the pharmacy, and he isn't trained to check your blood pressure. But make no mistake: He plays a significant role in improving the lives of everyone who comes through the hospital's doors.

Smith, an alumnus and an architect by training, is senior vice president of real estate and facilities at Hoag, and it is his job to ensure that patients and caregivers alike who traverse its halls see the hospital as an ally rather than an obstacle. He recalls what the hospital's CEO said during an orientation for new employees:

"Many of the people you will encounter in the hallways of this institution today are having the worst day of their life. They're coming to this place and they're under tremendous stress and emotional discord, and our job is to try to make them feel comfortable and at ease."

That observation applies not only to the quality of care but to the quality of the place where the care is offered. For Smith, that means assessing the hospital's design. "Are we confusing them and adding to their anxiety or are we doing things to help them feel more comfortable? It's an important question," he says.

It's a multitrillion-dollar question.

Health care, the largest segment of the U.S. economy, generates more than $2 trillion in activity annually. Significant developments, including passage of the federal Patient Protection and Affordable Care Act, the graying of the Baby Boom generation and the need to meet new seismic standards in California by 2020, will dramatically alter the way patients, doctors, administrators and a host of others involved in the medical field approach sickness and wellness.

Bob Kain, an alumnus and principal at HMC Architects in Ontario, Calif., says architects are like detectives. They discover bits and pieces of evidence, make sense of it, suggest scenarios and find answers. Meeting the demands of the health care revolution will be their biggest case in decades, and he and Smith want to help ensure that those
entering the profession are up to the challenge.

Their answer is the Healthcare Architecture Initiative, which sprang from a casual discussion over lunch last year after an event honoring Smith as the College of Environmental Design's distinguished alumnus. Smith suggested to Kain and Professor Judith Sheine, chair of the architecture department, that the college consider entering a design competition sponsored by Kaiser Permanente.

"It turns out that the competition had already closed," Smith recalls, "but it gave light to a sense that it would still be a great thing to encourage a new generation of thinkers to start addressing the complex problem of health care and health care delivery."

"Version 1.0" of the fledgling initiative, as Smith puts it, involves fundraising, forming an advisory board from the region's health care professionals and architects, and assessing the curriculum. The goal is to create a graduate specialty that would be the first of its kind on the West Coast.

Sheine says the pieces are in place to move forward.

"To get any program going, you have to make sure there's faculty support and faculty participation or, in general, it doesn't go anywhere," she says. "To get traction outside the school, there has to be interest and need in the profession. This [initiative] is a combination of both."

Kain and Smith both attest to the College of Environmental Design's importance in their career success, which explains why they jump-started the fundraising effort with $10,000 donations - one from the HMC Designing Futures Foundation and one from Smith himself.

For years, regulations and society's perception of health care impeded architectural innovation. Hospitals were staid objects of function but not necessarily form. "Patient-friendly" was not part of the lexicon. However, Kain says a new mind-set has evolved, one that views a medical facility as a vehicle for healing.

"It's not so much bricks and mortar - it's that people entering that facility need to be made whole," he says. "It's the use of natural light. It's smell. It's colors. It's something that will calm people. … It's that warmer environment, softer colors, less noise - not so much a home environment, but a soothing environment."

It's also about what Kain calls way-finding. How easy is it to get from the freeway to the medical facility? How easy is it to park? Is the signage clear? Can patients get where they need to go easily or must they navigate a labyrinth of hallways? Every detail matters because the public's perceptions of health care are different today.

"People are going to act more and more like consumers. … They're making a holistic decision about an experience," Kain says. "Health care is going to become more community based. While I'm waiting for the results of some test, can I go to a fitness center and do some exercises? Is there a coffee shop nearby with Wi-Fi? What is my health care experience going to be?"

Health care professionals and architects at Hoag got a glimpse of the future when a group of ENV students, under the tutelage of Professor Hofu Wu, shared their ideas in a series of presentations at the hospital.

The goal of the 10-week studio project was to design a medical office building that would not only complement the hospital but also incorporate the adjacent surroundings, including a nature trail and a river walk.

"They absorbed so much knowledge in such a short period and put their innovative ideas into the projects," says Wu, who has taught sustainable design for the past 20 years and health care design for the past seven. "They addressed some very complex problems."

The two- and three-student teams incorporated natural sunlight, provided easy access to gardens, made the facility intuitively navigable and even reduced the number of steps nurses would have to take in the course of a day. Many of the proposals emphasized energy efficiency and sustainability.

"Good design can be complementary to good health," Wu says.

Kain, Smith and Sheine agree. And the way to create positive experiences - experiences that make physical and fiscal sense - starts with a solid foundation.

"The key is teaching," Kain says. "The hospital of the future will continue to evolve, and the well-trained architect will be able to adapt to change because of a clear understanding of the goals of all parties in the health care process. That's what the Healthcare Architecture Initiative will try to achieve."