As we come out of this economic downturn, I believe that there will be changes in the planning and design of healthcare facilities. Shifts in healthcare delivery systems, design methodologies, and accountability for health outcomes appear imminent and will all drive change. We are seeing these transformations already emerge as we begin to climb out of this very difficult economic period.

How you respond to these shifts is part of an evolutionary process. “Survival of the fittest” comes to mind. I sat down with my staff recently and mapped how our 27-year-old design firm survived more than one economic downturn. As I charted our history, it became evident that we always went into a downturn behaving one way and came out of it behaving totally different. Our survival can be attributed to anticipating the shifts that were occurring and being nimble enough to respond with a different menu of services.

The anticipation of the shift and the preparation for what follows has allowed our firm to endure. As we think about our firm’s evolution, it’s interesting to note that current best practices have a shelf life, while being nimble enough to evolve into the next practice is enduring.

So let’s look back to look forward. What were those best practices of our past and what drove their next practices?

Technology. The late 1970s and early 1980s was a time when our services were linked to healthcare providers’ needs for burgeoning diagnostic medical equipment. That equipment and its required supportive infrastructure became the driver for facilities planning and design.

Reimbursement methods. The mid-1980s, influenced by revised reimbursement structures, brought us into a clearer focus about the needs of the healthcare consumer and what would drive their choice in a provider. During this time, many facility lobbies were redesigned to include a piano and a water feature. The patient’s first impression was studied and hospitality design rules migrated into healthcare design. Project funding added more than just what was needed for advances in technology; it added funding for items that would drive market share. Building the corporate brand became the driver.

Consumer demands. In the late 1980s and early 1990s, consumer choice strengthened and began to parallel medical preference for the selection of a healthcare provider. This gave way to the adoption of patient-centered care principles. Those principles started to transform the way care was delivered. A more aesthetic design principle moved from public spaces to patient care areas. Families were now welcomed into the inner sanctum of care. Improving the consumer experience became the driver.

Quality of care. By the late 1990s, when the Institute of Medicine revealed “To Err is Human,” a much deeper discussion redefined quality of care. Facilities planning and design needed to shift beyond equipment, brand, and the consumer experience to clinical safety. Organizational cultures transformed themselves and relevant design features followed with solutions that supported more accountable care delivery models. Safer outcomes became the driver.

Evidence-based design. At the turn of the millennium, the evidence-based design movement found its natural place in this safer healthcare delivery model. Its principles have taken hold and facility stakeholders are now expected to align solutions with strategic outcomes. Accountability has become the driver.

It has been 10 years and national healthcare reform is looming. We all feel the shift, but what will it be?

The best practices listed above will continue to evolve:

  • Smart technology will transform healthcare delivery and foster family connectedness to vast pools of medical knowledge;
  • New economic models for wellness and prevention will drive reimbursement structures;
  • Patient- and family-centered care will be factored into the economic equation of how best to serve a patient safely, effectively, and efficiently-not just within the four walls of a physical hospital;
  • Medical cultures will continue to evolve into more integrated team participation across much larger geographic networks, fostering quality delivery; and
  • Outcome driven design solutions will find their place as these best practices continue to evolve and transform care delivery.
    The signatures of President Barack Obama, Vice President Joe Biden, and Speaker of the House Nancy Pelosi on the health insurance reform bill signed in the East Room of the White House, March 23, 2010
    The signatures of President Barack Obama, Vice President Joe Biden, and Speaker of the House Nancy Pelosi on the health insurance reform bill signed in the East Room of the White House, March 23, 2010


In the next practice, Accountable Care Organizations will partner with a variety of stakeholders in order to respond to the reform mandates that will improve performances and drive efficient, effective models of care. Evidence-based facility planning and design stakeholders will own their own realm of accountability in a truly effective healthcare reform policy. I believe that the driver will be healthcare reform. HD

Rosalyn Cama, FASID, EDAC, is Board Chair for the Center for Health Design located in Concord, California.

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Healthcare Design 2010 July;10(7):8