The Durham File


  • Senior clinical advisor, SmithGroup
  • Executive vice president, Global Health Services Network
  • Principal, Health Strategies & Solutions Inc
  • Medical planner, Trinity Design/HKS


  • Founding member and president of Nursing Institute for Healthcare Design
  • Health Environmental Research & Design Journal (HERD) editorial board member and peer manuscript reviewer
  • Editorial committee member and contributing author of Nurses as Leaders in Healthcare Design: A Resource for Nurses and Interprofessional Partners
  • Board member of Hope Clinic International


  • University of Michigan, bachelor’s and master’s degrees in architecture
  • University of Michigan, bachelor of science in nursing

Joyce Durham, R.N., AIA, EDAC, Lean Six Sigma Green Belt, began her health care career as a nurse and realized early on the importance of caregivers having a voice in facility planning and design. This month, as president and a founding member of the Nursing Institute for Healthcare Design, she talks to HFM about that mission.

Why did you become interested in health care design and decide to pursue it as a career?

I became involved in health care design through a series of circumstances instead of a specific plan. Early in my nursing career, I was invited to participate in a transition committee charged with supporting the relocation of our unit from its dated building to a new bed tower. On my initial tour of the new unit, I was struck by how much the physical environment really affected the way care was delivered and the operational changes that would need to occur in the new space. This piqued my interest in health care design, and I went on to pursue a degree in architecture, which led to my 30-year career in pre-design services for health care facilities.

How has the Nursing Institute for Healthcare Design (NIHD) evolved over the years?

NIHD was founded in 2005 by Debbie Gregory, R.N., who pursued a degree in interior design because of her love for space planning and design. During her training, Debbie questioned whether the nurse’s voice was integrated into the design process. Because of this concern, Debbie and her colleague, Laura Hayes, asked a speaker at a health care design conference to announce a breakfast meeting for nurses interested in health care design. The following morning, 10 nurses showed up and the NIHD was born. Officially, NIHD became a nonprofit organization in 2010 with a mission of engaging and integrating clinical expertise into the planning and design of health care environments. Since that beginning, NIHD has expanded to 140 diverse members in 2018 with roles in architectural firms, consulting, health care systems, academia and manufacturing.

What are your major objectives during your term as NIHD president?

In the early years of the organization, the focus of our efforts was equipping nurses and other clinicians with the skills to participate in facility planning, design and construction. Basically, we wanted to ensure that the nurses’ voice was a part of the planning process. As our organization has matured, we are now focused on supporting our members in becoming leaders in all areas of health care, including facility design. We see their role as leading the health care planning team in challenging the status quo and pursuing innovation. In addition, we are equipping members to understand current research and to become involved in future research.

Why is it important to involve clinicians in the planning and design process?

If one ascribes to the architectural truism that “form follows function,” the design of a patient care space should be driven by the activities that occur within it. But, it is only with the nurses’ and other clinicians’ input, and often that of the patient, that we truly understand the function and how the architectural form affects the quality and efficiency of patient care.

For example, nurses raised their concerns about excessive walking distances, and research demonstrated that three key factors — the location of the charting space, medication room and supply rooms — have the greatest impact on walking distances. This information has shaped the size and configuration of inpatient nursing units such that walking is minimized. Similarly, nurses championed the importance of line of sight to patients and other caregivers. Research validated these concerns and architectural decisions to increase patient visibility and visibility of peer nurses have become common in inpatient unit designs.

With the ongoing and increasing challenges of cost efficiency in health care delivery, nurses are perfectly situated to help prioritize space utilization.

Are there programs in place to keep members engaged in the organization?

Even though our membership is diverse, our member surveys have shown that members’ top two priorities consistently are networking and education. As a result, our services to members include:

  • Monthly webinars on key health care facility planning and design topics that offer nursing continuing education units (CEUs) and Evidence-based Design Accreditation and Certification from the Center for Health Design.
  • Our community forum offers members a way to ask a question of their NIHD colleagues and receive answers to a wide range of topics relative to their practice in a short time frame.
  • Numerous networking opportunities are provided at our annual conference held in conjunction with a national health care design conference.
  • CEUs are offered for a four-hour pre-conference event presented by NIHD and 11 presentations with a clinical focus selected by NIHD at the same conference.
  • Also we are working with a consultant to expand our social media presence.

What are some of the partnerships NIHD has fostered?

NIHD recognizes that our impact and the support to our members can be expanded significantly through our academic, industry and professional partnerships.

Clemson University is an academic partner and several of our members serve as adjunct faculty in its School of Nursing. NIHD looks forward to supporting the Clemson University School of Nursing’s international nursing conference on excellence in health care design in 2019.

We have eight industry partners to whom we are grateful for support. In return, our members enjoy participating in focus groups, educational seminars and product evaluations to support their efforts. We are expanding our research efforts with this group of partners.

We also have had a partnership with the American Institute of Architects Academy of Architecture for Health (AIA/AAH) for several years. This has allowed us to share educational webinars between organizations and, just recently, include nursing students on the multidisciplinary teams at the AIA/AAH-sponsored student health care charrette at the International Summit & Exhibition on Health Facility Planning, Design & Construction.

We recently launched a partnership with Women in Healthcare (WIH), whose events are open to all. WIH has several leadership training opportunities that will expand our offerings in this area for our members and WIH members can participate in our educational sessions.

What are some projects on the horizon?

In 2015, NIHD members wrote a book titled Nurses as Leaders in Healthcare Design: A Resource for Nurses and Interprofessional Partners with the support of Herman Miller. The initial edition of the book is in its second printing and is available on our website.

Discussions are currently underway with publishers to revise the book and publish a second edition. In addition, our strategic plan includes an initiative to write another book focused on additional areas of health care design within the next five years.

Our strategic plan for the next five years also includes investigating a podcast, a quarterly journal and a speakers’ bureau. In addition, member training programs in research techniques are being developed, and research project funding will be increased.