It takes years to plan, design, construct, and open new healthcare facilities, and a lot can happen over the course of any building schedule. For projects submitted to this year’s Architectural and Interior Design Showcase, what “happened” was a worldwide economic downturn.

This year’s projects have been some of the first to illustrate the effects of that shift, with visible signs of facilities being scaled back—some a bit less lavish and a bit more efficient.

“What we’re seeing are more modest and right-sized projects. We are five years post-economic downturn, and seeing concepts that were derived or created during that time yields projects in physical form and delivery that are simpler. In an era of austerity and considerations regarding cost, it’s probably on time and on line to see projects that are representative of conservative planning and thinking,” says Todd Cohen, director, environment of care and hospital safety officer, MedStar Montgomery Medical Center (Olney, Md.), a member of the Showcase jury.

And while trends emerged that capture a greater focus on new delivery models, patient-centered design, and cost-effectiveness of design choices, jurors also noted that there’s a lot more work to be done.

Moving out
Though plenty of traditional hospitals and medical centers were among the projects reviewed by jurors, submissions were an indication of another shift taking place: the movement of treatment out of acute care settings. The year’s project mix includes ambulatory care centers, hospice care, wellness centers, and medical office buildings, to name a few. “This is clearly in line with the move toward understanding and addressing population health initiatives,” Cohen says.

Some projects specifically worked to put the patient first in this type of setting. For example, juror Janie L. Gawrys, Robert Wood Johnson Foundation, executive nurse fellow and vice president of clinical operations, Access Community Health Network (Chicago), noted Citation of Merit winner the Chief Andrew Isaac Health Clinic as an example of taking this step. “In the planning process, they spent time going out to remote locations to see what the people wanted. This is at the heart of patient-centered care and needs to be replicated more,” she says.

However, Gawrys says that from her perspective as an owner, not enough attention is being paid to patients overall, particularly in the outpatient setting. “Healthcare design is lagging behind. More and more the focus is not on the inpatient needs; that’s shrinking. The focus will be on patient-centered outpatient design. [Good] health begins long before you go to the doctor, so design that looks to keeping us healthy while partnering with preventive medicine is the future,” she says.

Technology touch points
In terms of addressing patient needs, Gawrys also notes that more needs to happen in inpatient settings, as well, especially in the patient room. “Patient rooms haven’t changed since the beginning of time. Expect to add more technology. I’ve seen very little innovation for the most important person in the inpatient or outpatient setting,” she says.

Juror Daniel J. Miesle, administrative director—space planning and transition strategy, Stanford Hospitals & Clinics (Menlo Park, Calif.), says he, too, is looking for facilities to step up the use of technology. “I was disappointed that projects talked about staff efficiency, but design did not reflect or respond to core process efficiency. I was very disappointed with the lack of care-related technology in design, especially in inpatient [facilities] and emergency departments,” he says.

Cohen notes, however, that he did see that attempts are being made on the IT front to better the patient experience by moving away from workstations on wheels and moving toward a closer, collaborative experience for patient and caregiver. And bringing technology closer to the patient for documentation and collection of information is a step toward a reduction in errors, too.

“The built environment and design intent of spaces can and do translate into increases in safer approaches to care and improvement in quality delivery, “Cohen says. “We can always increase training or find/develop better clinicians, but frequently we have one opportunity to construct a patient-centered experience that will be both safe in delivery and efficient and effective in its intended form.”

Connecting back to cost
Noting that he’s excited by designers continuing to raise the bar on creating beautiful interior spaces, Ryan Hullinger, principal/architect, NBBJ (Columbus, Ohio), says he’s still not yet fully seeing a connection between design and improved clinical performance. “In the future, it will be interesting to see the way that advancements in acoustics, ergonomics, durability, and adaptability are utilized more and more frequently by healthcare designers,” he says.

Miesle concurs, noting that a balance between design and cost-effectiveness will be critical in new reimbursement models that measure points like access of staff to patients and infection control. “I’m concerned for inpatient facilities that design is not reflecting quality metrics and indicators,” he says.

Furthermore, Miesle noted another trend that emerged from this year’s submissions: a connection not just to performance but to organizational values. “Design should reflect the image of the organization versus just a ‘wow’ factor,” he says.

Inviting innovation
In an era of cost-cutting in response to new economic realities, reform is jointly coloring the design outlook, with regulations a necessary part of the healthcare space that Robert Smedberg, healthcare sector leader, VHB | Vanasse Hangen Burstlin Inc. (Watertown, Mass.), says is restricting some of the innovation that may otherwise be brought to the table.

“Given the average life cycle of a design project and the present-day regulatory hurdles, it’s understandable that innovation, the essence of a better healthcare environment, can become the exception rather than the rule,” he says.

However, despite the economic challenges the industry has faced as well as uncertainties that remain, Smedberg says innovation isn’t just the end, it’s also the means.

“Innovation overcomes financial pressures, procedural hurdles, and logistical roadblocks to achieve the greatest healthcare facilities possible. Understandably, the challenges are enormous and the regulator process bears much of the cause,” he says. But he adds that as far as innovation is concerned: “We as leaders must be the champions.”

Jennifer Kovacs Silvis is managing editor of Healthcare Design. She can be reached at