Healthcare design is all about improving outcomes. Some of our targeted performance goals, however, are getting much more competitive and far more incentivized.

Everyone who works in a healthcare environment, including architects and designers, must strategically tie their actions to a continuous process improvement model, as reimbursement requirements continue to build on baseline performance measures.

Designing, selecting, and specifying products within these new mandates is not that different from what we’ve been doing as evidence-based (EBD) facility managers, designers, planners, and product manufacturers.

But the goals we state at the start of a project have a newly defined purpose. Results must now be tied to our clients’ evaluated performance, impacting their reimbursement scale.

Having built our baseline knowledge in EBD, with a focus primarily on patient safety, our professional community has made great strides in improving the delivery of quality care outcomes through the design of the built environment. While this remains an important outcome, design solutions also need to include environmental factors that:

  • Prevent hospital readmission
  • Improve pain management
  • Increase environmental cleanliness
  • Provide facility acoustical integrity
  • Improve clinical communications and responsiveness.

Pay-for-performance success is our driver, and the ultimate goal is patient satisfaction. Clients will be looking to us to identify solutions that have an outcome-based return on investment with significant lifecycle performance, in order to remain competitive.

Recommended steps to achieve this new paradigm might include asking if your project team has assessed the following.


Benchmarked national performance for specified products
The fine print found at the end of a specification now must take on new meaning. Like consumer ratings on most durable products, healthcare products will have to withstand the scrutiny of consumer perceptions.

Are you reading those performance measures? Are you holding manufacturers accountable for updating performance lab reports? Are they testing in the field and reporting successes and failures? Do we need to create an industry watchdog group to keep the competition on the same continuous performance track as our healthcare providers?

The industry has taken a turn and we all must heed the call to improve product performance aligned with care performance.


Baseline data from a qualified institution
In order to deliver the best solutions in a relatively short period of time, design teams will need to share performance measures in order for manufacturers to respond with new research and product development.

Team members, including the owner, need to make a personal commitment to owning the industry’s most current knowledge and tracking new projects’ tenacity to deliver at a minimum of what the current state of the industry expects from a building that has a 40-year lifespan.

One sure way to do this is to be certain all team members are reporting success and failures to a collective arbiter, instead of redefining quality as we’re accustomed to doing: one project at a time.


Innovation expectations to keep pace with continuous improvement
We’ve developed field study groups to report and incentivize continuous improvement around safety, such as acceptance of the single-bedded room. What new innovation can these new mandates unleash?

I’m sure we all have a file folder full of rejected ideas because they failed to meet an economic incentive but have a high return on investment over their lifecycle. As the rules change, the door may reopen for revisiting some of these ideas that could become the next best practice.


Project generosity
We all like to share project successes, but we should also share failures. The industry needs our honesty. There are many ways to share project success and failures.Use the tools available through this publication and its many venues, including its social media outlets and webinars, and consider submitting a proposal to speak at the HEALTHCARE DESIGN Conference.

If you’re conducting research , submit it for peer review through the Health Environments Research and Design (HERD) Journal. You can also connect with the staff at The Center for Health Design (CHD) and learn about opportunities to volunteer or share examples of your project’s evidence-based design features.


New vocabulary
As we shift the way we deliver projects, so will we shift the way we design buildings. These industry shifts will redirect our thinking, as our community baseline knowledge rises and becomes readily accessible. The best way to be ready for these shifts will be through EBD methodology.

I’d like to suggest an allegiance among industry members— one that shares each advancement and the resulting knowledge, creating universal access to lessons learned. That’s the work being done each day by CHD Affiliates. Together they stay connected to the industry and to each other, opening the door for greater industry advancements for performance measures without reimbursement penalties.

Rosalyn Cama, FASID, EDAC, is The Center for Health Design’s board chair and president and principal interior designer of Cama Inc., in New Haven, Conn. For more information on The Center for Health Design, please visit