Sift through the pages of Healthcare Design’s Architectural and Interior Design Showcase (appearing in the September 2013 issue), to see what’s current in healthcare design. This juried section features healthcare projects from design firms that developed solutions driven by operational delivery models conceived five to even 10 years ago. Today, designers are challenged with an even more complex environment, answering to pressures like advancing technology, an evolving health policy, and expanding institutional consolidation. Focusing on approaches that allow for future flexibility to answer the incredible speed of change taking place in care delivery, designers may start to feel like they’re aiming at a moving target.

Some years ago I was inspired by Connecticut-based futurist Watts Wacker, whose book (co-authored with Jim Taylor) “The 500-Year Delta: What Happens After What Comes Next” offers a fitting mantra for these times, particularly for architects and designers who are predicting design needs and creating solutions that will need to endure unseen operational changes. Everyone will no doubt have some part in imagining a rapidly evolving future, from designers to manufacturers to consumers experiencing the newly designed model of care. By now, I suspect many in the industry have discovered evidence-based design knowledge as a net from which to launch the “what’s next” innovative solution. But how do you use that intelligence to predict what will come? One way is to use a strategy Harvard Business School professor Clayton Christensen calls “disruptive innovation.” This strategy can be used with a deeper analysis of a project’s performance to dislodge the conventional practice of judging the design of projects solely on functional performance, capital budget frugality, and visual assessment. This is accomplished by not just looking at first costs, but also looking at the design of the whole, with an analysis of life-cycle costs to calculate a true return on an investment (ROI).

The disruptive force in ROI design decision-making is driven by the consequences of the Affordable Care Act. It requires us all to pause as we seek transformative breakthroughs to make healthcare accessible to a growing population, including access to the changing face of its facilities. I recall Cheryl Herbert’s need to insert a “pause phase” in her Dublin Methodist Hospital (Dublin, Ohio) project, because she felt time was needed to allow for evidence-based breakthrough ideas to come to the fore, which couldtransform and support her new model of care delivery. As a small, informed evidence-based design community, we have access to an expanded body of knowledge that positions us to ask the probing questions that will allow the use of critical thinking skills to examine, discover, and create the dynamic solutions needed in this performance-based marketplace.

One can say that the projects featured in this issue were the critical ideas before the pinch of health reform really put the squeeze on healthcare capital projects. Clues of a shift that’s taken place since their inception should be evident. Can you spot them? What’s on your design board right now that aligns with these shifts? New technologies, waiting rooms that are for admitting and not just waiting, EMR integration in the exam/patient room, quieter onstage/offstage care zones? Ponder the disruptive theories emerging in this issue and reflect on our collective need to pause, disrupt, theorize, and then design flexible solutions with a measurable return on investment . I hope to see you in Orlando in November for the Healthcare Design Conference, to ponder aloud.


Rosalyn Cama, FASID, EDAC, is president and principal interior designer of Cama Inc., in New Haven, Conn. She is the board of directors chair for The Center for Health Design and can be reached at