After nearly 30 years as a state regulatory authority, I didn’t expect to be viewed as a key member of a healthcare project team. However, early exposure to the tenets of The Center for Health Design gave me an awareness of the potential of my role beyond confirmation of compliance, as did working with like-minded state regulators within the revision process for the Facility Guidelines Institute’s Guidelines for Design and Construction of Health Care Facilities.

In Healthcare Design’s Take 5 with Mary Frazier, principal at EwingCole, Frazier observed that the hospital of the future doesn’t currently exist. This led me to think about how difficult true innovation can be in our industry. Though codes and regulations are written in black and white, we all know that unique situations requiring interpretation and judgment occur regularly. Likewise, true innovation may require more focus on the “intent” of a written standard rather than the words used to define it.

Government’s role in protecting the public is vital. But in today’s fiscal environment, many state regulatory agencies are struggling with maintaining sufficient resources for a growing workload. More effort is expended on redundant tasks verifying the work of other experts (architects, engineers, and healthcare providers) than on improving patient safety and outcomes. Given the pace of clinical and technological advancement in healthcare, I believe today’s regulatory infrastructure may be obsolete—to the detriment of overall healthcare cost and true innovation.

Innovation is required on many levels:

  • Most state regulations, including many referencing the FGI Guidelines, include language that allows alternate means of compliance and determinations of equivalency. Become familiar with this language, as it can often enable a collaborative discussion with your state regulator when an innovative design element is proposed.
  • Due to resource and time constraints, the words defining time-worn state regulations and enabling policy may be overly restrictive. Working with your regulator to review and revise these critical governing criteria could open the door to new models and methods of care.
  • With financial feasibility and capability critical in our current cost-intensive environment of healthcare, working with your regulator to recognize new models will likely require complementary innovation in reimbursement assumptions and policies. A more collaborative relationship can facilitate those discussions, as well.

We can all improve this condition by looking at our state regulator as a valued team member versus a necessary evil. By engaging our regulatory agencies in regular dialogue, we can better assure them of compliance and allow them to focus limited public resources on rendering consistent interpretations in a timely manner, and maintaining clear and up-to-date construction and design standards.

Many codes and regulations are written with the intention of preventing something bad from happening. Perhaps viewing such standards from a different perspective might help us all use them to help good things happen.

Thomas M. Jung, R.A., Thomas M. Jung Consulting LLC (Albany, New York), currently serves on the Center for Health Design’s Board of Directors and does limited consulting. He can be reached at