What do The Cheesecake Factory and the University of Pennsylvania Health System have in common? It was a question Earl Marsh pondered after reading “Big Med,” an article by physician-author Atul Gawande that was published in the New Yorker and considered whether hospitals should be more like chain restaurants.

The common goals struck Marsh, Health System Architect, Real Estate, Design and Construction for the University of Pennsylvania Health System (UPHS) in Philadelphia, as similar. Each industry aims for a pleasant environment that delivers consistent and predictable services. And both are in constant change.

But how exactly does an inside architect contribute to ongoing change with a distributed approach to leadership? “You better know where you’re headed before starting out,” Marsh advised Healthcare Design conference attendees in Phoenix.

Commonly known as Penn Medicine, the large, four-hospital system has 2,000 physicians and 20,000 employees. Its footprint is more than six million DGSF across the tri-state region of southeastern Pennsylvania, Southern New Jersey, and Delaware. Marsh’s department’s mission, he shared, is “To guide the planning design and construction of facilities to achieve the programmatic goal within the set boundaries of schedule and budget.”

He has tools and processes in place to tame project proposals in the large integrated healthcare system. Those wanting to design or build start the process with a Request for Service and close communications with senior leadership and budget proposals. As the project wends its way toward potential approval, he and his team not only collect data on the proposed project, they educate the proponents on the design and execution process. All parts of the plan are documented and all tools are online.

When it’s time to design and build, Marsh likes standardization. Standard spaces, standard materials, and standard configurations across all facilities as much as possible. Exam rooms, for example, are the same size and configured the same for handwashing, charting stations, and opportunities for visual contact with patients across facilities within the health system, enabling physicians to move effortlessly from one site to another.

Marsh is so pleased with standardization efforts that he plans to expand them with clinical modules with check-in and check-out stations and off-site fabrication of materials.

How the design and construction industry can support ongoing change

To support the ongoing change at Penn, Marsh offered some direction to potential partners.He and his team want consistency in the support team (that is, the same people throughout the project), as well as understanding of their business and the scope of the project. Collaboration and creativity are important, as is code expertise. “Much of what we do is mandated by code,” he notes, “so if you don’t have a code expert, hire one.”

It is also vital that partners have current knowledge of best practices and, as he said, “Don’t let us do anything stupid.”

What about healthcare reform?

Healthcare reform is an issue at UPHS, Marsh said, but its response mainly focused on the IT infrastructure in existing facilities, he said. “They are not really thinking about the impact to building.”

But Marsh has and he forecasts four facilities response drivers. He expects to see even more hospitality focus as well as increased attention to patient and family center design as well as guideline mandates. He also thinks demand for designs that make provisions to provide care for the caregivers, such as renewal centers for nurses, will grow.