Healthcare Architecture: The Requirements of Becoming an Expert
In this interview, Marisa explains how her healthcare background has been instrumental in supporting her role as an Accommodation Expert, the nuances of opinion evidence and the importance of remaining in practice.
Why is an architect best placed to be an Expert Witness in providing accommodation reports?
Architects come from a diversity of academic backgrounds, but we all share the common foundation of learning how to decipher our client’s requirements and translate them into 3D design solutions; we are trained to be problem solvers.
As a Healthcare Architect, I enjoy the task of reconciling the differing needs between the patients and those of the people actually providing the care (clinicians for instance), in order to create an environment that facilitates the best outcome for all parties. A classic conflict in designing hospital inpatient areas is the need for patients to be observed by nursing staff, potentially clashing with the patients’ right to privacy. Ceiling mounted hoisting (for people who need transferring from say a bed to the toilet) can be an emotive issue. Carers and nursing staff are bound by Manual Handling Guidelines, but some hoisting solutions can compromise a patient’s experience and their dignity.
Another design goal is to create environments that are non-institutional, non-clinical and more humanised.
It needs to be emphasised that inclusive design and environmental accessibility are inherent within healthcare design agendas and not, as it is frequently, considered as an ‘add-on’ to building projects, as a tick box in meeting Building Regulations. A common thread in our design principles is the goal to create an environment that requires minimal mechanical means and at the same time maximises independence for all, regardless of ability. In my view, it is lazy and damaging to simply rely on installations, such as a platform lift, to resolve a problem that can be mitigated with an architectural design solution. In some cases, the mere presence of such installations can bring about psychological barriers that would be counter-productive to promoting independence.
Another design goal is to create environments that are non-institutional, non-clinical and more humanised. This necessitates the consideration of the sociocultural, emotional and holistic needs of the inhabitants without compromise to the function. This is often a tricky balancing exercise but can be enabling for the occupants and contribute to health and wellbeing when it is achieved.
You cannot be an Expert in being an Expert!
Assistive technology is a fast-flowing landscape, and while robotic limbs (think Claire Lomas) and digital aids are becoming increasingly available, as Architects it is important to stay relevant and keep abreast of the latest technologies and this is an agenda we embrace.
While Accommodation Experts from other disciplines may have occupied this field for many years, I believe it is the wide-ranging skill set of Architects that can appropriately address the varying accommodation issues that are inherent in complex and often high valued claims.
Design aside, Architects will be trained to understand construction and contract law, but traditionally, we will have little understanding of the legal process and the Court system.
What are the requirements needed to be an Accommodation Expert?
You cannot be an Expert in being an Expert! Every Expert, regardless of their field, will not only require a solid foundation of practical experience but they will stand in better stead if they remain in practice for the duration of any CPR Part 35 obligations.
All of the Experts in the Cowan team are a practicing Healthcare Architects. We have all specialised in this field as we feel that we’re making a difference to people’s lives at a time when they are most vulnerable. It takes a certain type to want to do this and we get very passionate about using design as a problem-solving tool, and making a positive impact.
Design aside, Architects will be trained to understand construction and contract law, but traditionally, we will have little understanding of the legal process and the Court system. Appropriate legal training is required; and all our Experts have needed to upskill in this area and have all completed the demanding University of Cardiff Accredited Expert Witness Certificates.
In cases where the claimant and defendant start from very opposing positions, it could be tempting for Experts to be drawn into advocating for either side.
What added value do your accommodation reports provide the Court and what can go wrong?
The purpose of an accommodation report is to advise the Court on technical, architectural and housing aspects around the quantum of a claim. Every case’s focus is on an individual who is unique in their presentation and needs. Correspondingly at Cowan Architects, we provide a bespoke response by tailoring our assessments and subsequent report to the individual and their circumstances.
What can go wrong? In cases where the claimant and defendant start from very opposing positions, it could be tempting for Experts to be drawn into advocating for either side. In all cases, whether or not they make it to Trial, advocating by Experts could result in a distorted and unjust outcome. Not only is this unhelpful in establishing compensation levels, but it is also not conducive to the long-term efficacy of the Judicial System in preserving justice as it sets precedents for future cases.
A visit will also enable the Expert to assess the suitability of the current home, consider potential scope for adaptations and if appropriate, to form a benchmark from which costs are to be uplifted.
It is for the legal teams to set out their argument. However, our Experts Witnesses are familiar with relevant case law and can help the analysis of individual debated issues in the presentation of their report, whilst maintaining impartiality. For example, Roberts v Johnstone and in the time of a negative discount rate has sometimes led to the consideration of property rental solutions as well as purchase; Whiten v St Georges’ Healthcare Trust encourages parties to look at the circumstances around parental contributions throughout a child’s life and progression into adulthood; Reaney v University Hospital of North Staffordshire NHS Trust is interesting because it assesses the impact of pre-existing conditions and states that it is not a linear subtraction exercise in terms of quantum calculations. Providing that there is sufficient evidence to support each scenario, we can separately evaluate the accommodation related costs associated, for example, with an uninjured scenario, a pre-existing condition or individual co-morbidities.
These principles aside, ultimately accommodation reports need to be impartial, robust and withstand challenge – they cannot be ‘off-the-peg’.
There’s a high level of co-ordination required to set out complex solutions and be responsive to the external push and pull of an adversarial system whilst also maintaining our impartiality.
What is the usual process that you follow when instructed to a case?
Each of our instructed Experts will always insist on interviewing the Claimant. We believe this is a key part of the process from which significant information around domestic arrangements, personal lifestyle choices and future aspirations can be elicited to inform the basis of our recommendations. A visit will also enable the Expert to assess the suitability of the current home, consider potential scope for adaptations and if appropriate, to form a benchmark from which costs are to be uplifted.
All adaptation leads to a cost and it is our role to identify firstly, the need and secondly, the value. One of the greatest advantages of being an architect in a practice responsible for a high turnover of building work is having involvement in evaluating cost tender returns and access to real construction estimates. We don’t work in isolation as many other Experts might, and we constantly challenge and refine our processes in an attempt to give the best service to our clients and the most helpful to the Courts.
There’s a high level of co-ordination required to set out complex solutions and be responsive to the external push and pull of an adversarial system whilst also maintaining our impartiality. The Experts at Cowan Architects are very comfortable with this.
Marisa Shek, Architect, Expert Witness, Director of Cowan Architects
9 – 10 Old Stone Link
Tel: 01342 410242
Alongside her day to day role as an architect, Marisa accepts expert witness instructions to advise on the accommodation needs in medical negligence and personal injury litigation. She has undertaken cases involving stroke victims, spinal injuries such as Cauda Equina, limb amputations following orthopaedic complications, loss of sight and also complex claims for infants with cerebral palsy.
Following 19 years of practical experience as a healthcare architect, Marisa has developed expertise in the needs of cognitive, physically and visually impaired people, with a particular interest in orthopaedic, spinal and paediatric provisions. She is also on the Executive Board of Architects for Health which is a UK organisation championing excellence in healthcare design
As a Director, Marisa is integral to the Senior Management Team where she plays an active role in business development, building the Practice profile as well as day-to-day coordination of workflow across the team.
As Quantum Experts, the Cowan team provide reports on the accommodation needs of people who have suffered injury or trauma and are seeking compensation through the Courts. They interpret the Claimant’s needs, assess the impact on their home environment and evaluate the costs for adapting or relocation to a suitable alternative.