Every new concept that wows an industry eventually reaches the day when its application isn’t as exciting as it once was—when it’s no longer labeled as innovative. But that’s not necessarily a bad thing, especially if that concept held enough value in the first place to see its adoption become standard practice.

That’s been the case for many solutions that once took the healthcare design industry by storm, such as access to natural daylight or the use of healing art. Their presence throughout the 100 submissions to this year’s Healthcare Design Showcase was noted by the program’s 25 jurors, who at the same time recognized that the trend left this year’s crop looking pretty similar to those of previous years.

“You wouldn’t be wrong if you said there hasn’t been any progression, no real improvement year over year,” says Peter Lambur, architect and principal at Peter Lambur Architect Inc. (West Vancouver, British Columbia, Canada). “But then you’d be missing the point: The overall quality of the submissions is rising to meet the standard set by small handfuls of pioneering exemplar projects over the past five to 10 years. This is a very significant development that augurs well for maintaining a high standard of design into the future.”

While the innovations of old settle in to become expectations for modern medical environments, the next big idea remains elusive. However, jurors saw hints of what’s to come revealed in a review of the projects (featured in a supplement in the September 2014 issue of Healthcare Design), especially as the industry shifts gears to respond to a quickly changing healthcare landscape and client needs that are evolving equally fast.

Patients in process
When projects now in progress or recently completed were launched, healthcare was still in a state of limbo. To that end, many of this year’s Showcase submissions illustrate organizations’ interest in earmarking limited capital dollars for projects that didn’t go out on a limb in predicting the direction care delivery might take and instead looked to operational improvements, notes Kim Ritter, an associate at GBJ Architecture PC (Portland, Ore.).

“There seems to be more investment in the partnership between care providers and the design teams in the pursuit of Lean, care quality, and cost effectiveness,” she says. Specifically, submissions showcased a keen interest in patient and staff spaces, particularly in creating tangible results like higher satisfaction.

Lambur highlights the success projects had in achieving a deeper understanding of the patient journey that goes beyond more traditional concepts of on-stage and off-stage flows, for example. “There was a uniformly high level of functional concept planning. In several cases, designs for patient/staff/service circulation are built on operationally driven Lean design principles, skillfully blended with wayfinding solutions,” he says.

Avein Saaty-Tafoya, CEO of Adelante Healthcare (Phoenix), saw the trend translated to ambulatory facilities in particular, with building flow merged with the patient experience. “It was encouraging to see that more of these spaces were designed with the perspective of the patient and authentically removed barriers to care while improving movement and choice. It seemed to me that this was accomplished in fewer square feet, changing the paradigm of multilevel medical office buildings to smaller, more efficient footprints,” she says.

This process-based innovation, Lambur says, was characterized by design teams’ use of integrative tools and techniques to drive solutions, such as, “a comprehensive stakeholder-focused approach to creating and operationalizing a new model of care (Children’s Hospital of Richmond), a best practices matrix used to monitor and measure project performance (Ty Cobb Regional Medical Center), and a clearly articulated suite of operational/patient-centered/community engagement metrics (Sacred Heart Pediatric Emergency Department),” he says.

International flavor
This inward, operations-focused approach found on many projects was certainly indicative of the state of healthcare in the U.S. today, and had some influence on two international projects taking home the Showcase’s Award of Merit honors—South West Acute Hospital in Ireland and Chris O’Brien Lifehouse at Royal Prince Alfred Hospital in Australia—a first for the program.

As designers integrate innovations born in the U.S. into practice internationally, it’s presented an opportunity to advance what’s been achieved in way that American projects submitted this year didn’t reach. “It’s exciting to know that the U.S. standard of healthcare is so progressive; however, after reviewing the projects, these standards seemed to now be the norm and are expected,” says Kara Freihoefer, an associate and research specialist at HGA Architects and Engineers (Milwaukee). The two winning international projects “successfully blended these standards with a versatile, mainstream modern design appeal. The appearance of these projects was fresh, relevant, and different.”

Lambur agrees: “The influence of American architects is pervasive, but as healthcare design ideas are disseminated globally, it’s often others who adapt best practice design solutions to a local context with surprising results.”

For example, Ritter compares design responses on two projects with massive square footages: Mercy Health’s West Hospital in Cincinnati and the South West Acute Hospital in Ireland. “These two solid projects illustrate a vastly different response to designing an acute care hospital,” she says.

Ritter notes that while the Mercy project, an Honorable Mention winner, exhibited a lot of design skill to overcome its massive floor plate, the Irish project broke down its similar size by creating more of a village scale than an institutional one. “Aspects of acute care design that tend to be elusive in many U.S. hospitals—the sense of community; approachability; access to light, air and views—are indigenous to [South West Hospital’s] design by virtue of its massing and integration with the site,” she says.

Steve Stokes, senior associate vice president at RTKL (Chicago), says he anticipates U.S. providers will remain inclined to play it safe for now, with this crop of Showcase projects illustrating an era of caution stateside. “International projects are striving for U.S. design innovation and expertise, and are willing to take chances. Our U.S. market is bottom-line focused, utilizing tools that will greatly assist in their efforts to stay profitable,” he says.

While the pressures the U.S. healthcare market is under shaped what was and wasn’t seen in the submissions this year, it’s also influencing what jurors anticipate is on the way—particularly when it comes to the next wave of innovation.

 “The delivery of care is changing. The innovation will be dictated by data, technology, and the need to be nimble, flexible, and responsive. Design and delivery will be more in sync. Reduced waste will apply to process and production,” says Upali Nanda, vice president and director of research for HKS and executive direc
tor of the firm’s nonprofit Center for Advanced Design Research & Evaluation (Houston).

Saaty-Tafoya says her hope is that innovation will be illustrated in the evolution of building components. “I would love to see more repurposed materials, manufacturing techniques, and sustainable sources for decreasing costs and increasing durability of structural materials and finishes,” she says, with other jurors calling for the increased use of prefabrication and modular building components.

Another inescapable piece of the future of healthcare is technology and fulfilling the needs of a digital generation that will rely heavily on IT in the care delivery process. “We have some of this technology now in the form of health-monitoring devices, but it’s in the early days and we can expect a new era of automation and advanced applications to shape healthcare service delivery and facility design in the near future,” Lambur says.

With reform and revenue influencing much of what’s been built in recent years, the exact shape healthcare design will take—and the next solutions to evolve into standards—is still very much up in the air. “Our design industry believes the future to be innovation, but its current state is still in transition,” Stokes says.

Jennifer Kovacs Silvis is executive editor of Healthcare Design. She can be reached at jsilvis@vendomegrp.com.

For more Healthcare Design Showcase coverage, see the following: