The Williams File
- Executive director for construction review services at the Washington State Department of Health.
- Associate at Earl Swensson Associates in Nashville, Tenn.
- Project manager at ANFA Architects in Memphis, Tenn.
- Chair for Committee on Healthcare at the International Code Council.
- Vice chair of the Health Guidelines Revision Committee at the Facility Guidelines Institute.
- Accomplishment listing 3Vice chair for the Emergency Conditions Committee at the Facility Guidelines Institute.
- Member of the health care codes and standards review and various NFPA 99 committees at the National Fire Protection Association.
- Bachelor of science degree in architecture from the University of Memphis.
Although he is an authority having jurisdiction (AHJ) in Washington state, John Williams nevertheless has carved a national niche as a go-to person for codes and standards questions in the health care arena. This month, he talks to Health Facilities Management about his work in the field and with various regulatory bodies.
How did you first get involved in health care design, and what interested you in the subject?
My first interaction with health care was in the early 1990s when we were working with a Memphis, Tenn., hospital implementing a computer-aided facilities management system. A few years later, I started working with a health care design firm in Nashville, Tenn., and was instantly drawn to the intricacy of the projects. Hospitals are like little cities, with complicated overlays of processes and systems. The complexity is beguiling.
On a much more philosophical level, I believe that health care spaces are in a way sacred. They are places where we heal and grow; they are where we first meet our children and where we part ways with the ones we love. The community of folks who design and operate these places exercise that trust with an incredible amount of care. I feel really fortunate to be a part of it.
When and why did you move over to the regulatory side of health care design?
Interest in the regulatory side came from working with state departments of health across the country. It was intriguing to hear from groups of folks that had exposure to a large breadth of projects. They were able to bring a unique perspective from that exposure and from their experience with drafting the rules that we were using. I didn’t always agree with their perspectives, or the rules for that matter, but I appreciated the acknowledgment that design of these spaces were important. A great opportunity came up in 2003, and I came to work for the state of Washington. This position has allowed me to participate in hundreds of projects from the health care boom in the early 2000s to the pandemic response.
How has your background in the private sector helped you as an AHJ?
AHJs are charged with bringing a critical eye to a project, and the codes we use guide us to focus on a particular aspect of a project. It’s essential to have a broad perspective in order to put the issues we find in proper context. It also helps you relate. Often, even the best-trained, best-intentioned design team will have a code or documentation flaw. That does not mean they are incompetent or that they are doing it on purpose. Health care projects are just downright intricate. Too often it feels like a tug of war between an AHJ, owner and designer defending the code or a decision or precious resources. We can fall into a trap where compliance comes begrudgingly, and people are treated as obstacles to be battered through. This goes both ways, of course, and I’ve felt the results from both sides. Hopefully having a broader perspective leads to a culture of quality rather than a culture of mere compliance.
Where along the way did you get involved in Facility Guidelines Institute (FGI), International Code Council (ICC) and National Fire Protection Association (NFPA) activities?
While working with the state department of health in Washington. In the regulatory world, it is hard to avoid becoming interested in code development. The codes are our primary tools, and we work with them day in and day out. I am very fortunate to have had some great people encourage me along the way.
What do you see as the greatest differences among the FGI, ICC and NFPA development processes? Do you prefer one over the others?
The structures of the processes are big differences for sure. Each organization has its own specific steps to test existing assumptions and inject new ideas. None of them are necessarily quick or easy, but that’s not the point. The goal is to give every new idea a fair chance, and a thoughtful, deliberate process allows that to happen.
Each organization has evolved very similar tools to accomplish that: ICC uses topical committees to develop proposals. Those proposals, as well as all public proposals, are given equal footing at large biannual hearings. NFPA processes their proposals through topical committees and uses their annual meeting to focus on significant or contentious issues. The FGI uses similar tools but has a structure that values focus and agility to respond to issues, which reflects their culture of flexibility.
I have no favorites — they all have their advantages and disadvantages. At the end of the day, each finished publication represents thousands of hours of work by a wide swath of experts from across the country. While it’s not perfect, it is a very legitimate way to approach public health and safety.
What do you think has been the greatest achievement of the ICC Committee on Healthcare?
The committee has done some amazing technical work, both to promote consistency across jurisdictions and to move the code in new directions. We could talk about hundreds of specifics like smoke compartment size, occupancy reclassification and assistive toileting designs. The biggest achievement, though, is reframing the perception of health care facilities.
Everyone knows health care buildings are special, that they have a special set of risks and a bunch of complicated systems. Sometimes this makes people afraid of them. If you’re afraid, then there is no means too far to protect the occupants. To be certain, we do need to design hospitals deliberately and carefully. I believe the ICC Committee on Healthcare has helped put those risks in true perspective. The ICC community came to recognize that the first responder to an emergency in a health care facility is a staff person of that facility. A facility manager is the de facto AHJ within their own facility — a real-time set of eyes and ears.
It’s not just up to the building official or the fire department to ensure the safety of patients. Instead, it is a robust, cross-disciplinary public agency or owner, state and federal regulator partnership to keep patients safe, not only from the threat of fire or building collapse, but from the infection control and public health challenges that facilities face daily. That burden does not fall on just one person. Once we explore the depth of that partnership, we can have meaningful discussions about what safety means.
What do you see as the greatest challenge to the health care physical environment in the next decade?
To me, it’s less about how we’ll build something and more about the question of what we’ll choose to value. I’ve got a lot of confidence in our community — we can design and maintain buildings that are safe, appropriate for the function and usable. We’ll have setbacks and surprises, of course, but we’ll keep moving forward.
The tougher question is deciding what we choose to invest in. There are just so many needs. We have a set of public health crises to address, such as COVID-19, behavioral health and substance abuse. We need to ensure safety and quality in facilities. We are getting better at recognizing that all populations are not served the same, and we need to address those inequities. The problems are complex and confounding.
Untangling the complexity and prioritizing it down to a set of conscious and deliberate choices is going to drive what the health care landscape looks like in the next decade.