Healthcare futurist Joe Flower, founder and CEO of Imagine What If Inc., was very clear on precisely what he sees coming down the pike: change. “I don’t know anyone who thinks healthcare works, that it doesn’t need to change,” he said as he launched into his July 23 plenary session at the ASHE Annual Conference in Atlanta.

And while Flower said that change isn’t only happening quickly but chaotically, he also expressed optimism to his crowd of healthcare engineers, owners, architects, etc. “I think we’ll be good at it,” he said.

Reviewing familiar statistics on the habitual climb of healthcare costs in the U.S. over decades, as well as their vastness in comparison to other developed countries, Flower explained that in a fee-for-service business model, hospitals are paid for “doing things.” And in that model, the way to make a profit is not just to do more but to do more complex procedures and push utilization.

But in a new reformed healthcare environment, organizations will need to respond to a new business model that’s value-driven. And part of reverting to this new normal, and still finding a way to profit, will be determined by the ability to cut out waste. “It’s an industry that’s used to getting paid for waste,” he said.

And that’s where those who determine how facilities can best be run step in, bringing their best thought, work, creativity, and experience to the table. “There is a better healthcare out there; it needs help getting there,” Flower said.

So in order to provide better care at a lower cost and cut out waste, Flower said facilities themselves will need to run as efficiently as possible, with a close eye on recognizing the costs of ownership. For example, dollars spent on complications relating to hospital-associated infections or falls don’t have to be fixed costs; instead, facilities can implement operational programs or design initiatives that address these issues.

“How can we avoid these costs? This is your great asset,” he told the ASHE attendees.

Flower pointed to approaches like Lean and evidence-based design, citing The Center for Health Design’s Fable 2.0 hospital project that used research to show that despite spending $29 million more on a project to institute those very types of programs (initiatives that reduce infection control, falls, length of stay, staff turnover, energy use, and so on), the payback was 3 years to have a hospital that would be cheaper to operate.

But thinking about the future of the physical environment and how to best operate it for what's to come in healthcare includes a look at new venues, too, Flower said. For example, movement toward a focus on primary care to keep people well, onsite clinics at offices, home care, and retail clinics.

Flower also urged consideration of the movement toward strategic use of mobile health applications, as smart phone usage has grown exponentially over the course of less than a decade. “It’s ridiculous to imagine that it doesn’t become central to how we do healthcare,” Flower said.

And when a $300 mobile device replaces an $800 test, revenue is reduced and hospital departments will collapse. However, the need for support of those devices and diagnostics will call for new departments and expansion of existing ones—yet another path for the physical environment to take in its support of new care delivery models.

Flower urged attendees to consider the change taking place and how to find ways of doing things cheaper while giving patients what they need. “This is a call to be a revolutionary,” he said.

For more on Joe Flower, see coverage of his talk at the 2012 Healthcare Design Conference in “Supporting the ‘Next Healthcare’” at