Put a new healthcare facility smack in the middle of the recession and impending healthcare reform, and what you get is much of what’s captured in the 2015 Healthcare Design Showcase to be published in the September issue of Healthcare Design—projects planned, designed, and built at a time when the market was, if nothing else, in flux.

In their review of the program’s 64 submissions (with 55 projects approved for publication), jurors—ranging from designers to academics to providers—say some of the most successful designs answered the financial constraints that were inherent to that moment in time (and still are). Budgets were top of mind and creating efficiencies led the pack in terms of notable built environment initiatives.

Other design solutions emerging as hallmarks for this year in review include a focus on providing access to nature, progressive ambulatory care environments, and a re-engineered healthcare workplace. And while each stands to accomplish unique goals, the benefit to health systems and their bottom lines wasn’t lost on jurors, either.


Spending and streamlining
Although fiscal responsibility was noticeable in the projects, it was defined by smart design rather than questionable value engineering. “Many clients are understanding the concept of onstage areas versus offstage. The most successful projects know when to splurge and when to save. It’s a similar concept to wearing your Chanel jacket with an old pair of Levi’s. If you get it right, the higher quality items will make the budget purchases feel more expensive,” says juror Toni Wyre, director of interiors for WER Architects/Planners (Little Rock, Ark.).

Juror Scot Latimer, president of Latimer Health Strategies (Evergreen, Colo.), agrees: “[There was a] much better use of limited budgets. Money was spent where it had the greatest impact.”

Designs were tempered by budgets aesthetically, with many opting for more efficient workflows than hospitality comforts. However, often present to balance practical choices were organic and natural elements, an approach Wyre says makes sense. “As we streamline the architecture into a more modern and efficient (a.k.a. affordable) aesthetic, nature is a great way to soften the edges and it remains classic and timeless.” Beyond interiors, many projects also incorporated outdoor views and access to nature, an evidence-based design approach proven beneficial to patient outcomes and length of stay, making it an effort that pays off. 

Overall, though, it was those operational efficiencies that were king of the hill. “It was interesting to see how many clients are embracing the Lean model for buildings. This seems to have been a big driver for the design teams in space planning,” Wyre says.

While the timing of these projects inspired budget-friendly designs, those efficiencies may have also suffocated true innovation—even despite words such as “evidence-based design,” “sustainability,” and “collaboration” being pervasive in project descriptions. “Put all the words into practice,” urges juror Kenneth Kaiser, manager of facility renovation at Northwestern Memorial Healthcare (Chicago).

Latimer says that there likely wasn’t much tolerance for risk, though. “I think the economics of the profession combined with the client needs for speed to market have squeezed much of the time for innovation out of the solutions,” he says. But when considering missed opportunities, Latimer adds that with a health system undergoing so much change, it’s time to move beyond last year’s answers. “Everybody noted a Lean process as if it were something special and not a baseline requirement for good design. Process and solutions must continually advance.”


Function and flow
This year’s crop of Showcase projects still captured plenty of promise, including new models supporting care and operations.

For starters, clinics were all the rage, with wellness and specialty care practices growing in prominence over years’ past, likely in response to providers’ ongoing shift toward population health management and increasing numbers of insured patients. “As patients demand immediate care, walk-in clinics are emerging everywhere. I think this will eventually level off, but it may take some time before we realize the true effect of the Affordable Care Act. For now, it feels like the gold rush of 1849 as clinics rush to come online to meet demand,” Wyre says.

Beyond those triggers, the outpatient market also provides less costly settings to deliver care. “And [providers] are trying to capture/hold onto market share and integrate acquired physician groups,” says juror Phil DeBruzzi, executive lead at Blue Cottage Consulting (Ann Arbor, Mich.).

One of the ramifications of that trend is a newcomer to building solutions: “There is clearly a new building type to contend with—the ‘big box’ ambulatory care center, which health systems are deploying in response to the challenge of population health and integrating newly combined medical groups,” Latimer says. These one-stop shops often provide myriad specialties within a single setting immersed within a community to provide easy access to care and overall convenience in delivery.

However, Latimer says it’s not without some flaws. “These are more than medical office buildings, but the solutions are inconsistent and fail to address the challenges of patient flow, provider efficiency, and multidisciplinary practice,” he says.

Overall, new trends in workspace design were stepped up this year, too, with more collaborative, decentralized models that improve visibility between caregiver and patient as well as from clinician to clinician, DeBruzzi says. Adds Kaiser: “Fully distributed nursing seems to be disappearing in favor of a hybrid model of distributed small group, collaborative caregiver spaces. This, I think, is a good move.”

Additionally, technology is being integrated to support staff functions, such as compact charting stations at the bedside eliminating the need for the more clunky workstations on wheels. However, some jurors noted that this trend didn’t progress enough.

“I saw numerous instances of distributed workflow designs, but not a single narrative about innovative utilization of technology to support the designed space. Form follows function. Function reflects workflow. Workflow is driven by technology,” says juror Von Lambert, senior project manager at Rider Levett Bucknall (Chicago). “What I was looking for were designs that leveraged technology to enhance the staff’s ability to direct, communicate, and act to improve outcomes, efficiencies, and experience.”

Juror Zhe Wang, Yellow River professor at Henan University (Henan, China), says she’d like to see more research to support design solutions, as well. “The big-picture takeaway is that the gap between design practice and research needs to be further addressed,” she says, asking for post-occupancy evaluations measuring strategies such as centralized versus decentralized nursing and same-handed versus mirrored rooms. “The voices of design users, including healthcare professionals and patients, are needed to support user-focused design,” she says.


Back and forward
Institutional in nature, healthcare often doesn’t change and adapt to market forces as quickly as other industries. For example, Latimer points to big business as setting an example to which healthcare workspaces can aspire: “If the corporate world is able to push to 150 square feet per workstation and below while improving the environment for work, we have much to learn.”

Car manufacturing was referenced by another juror. “Just as the automotive industries have designed technology into vehicles that enhances the driver’s ability and experience through augmentation, automation, and situational awareness, I would like to see future [Showcase] entries discuss how the facility is designed as a component in the delivery of healthcare, not just the container,” Lambert says.

From care delivery and outcomes to patient flow and operations, there’s no shortage of problems in healthcare to solve. On these pages, we find both new solutions and new challenges. And next year, there will be more to come. “This industry draws those who relish a challenge, and with big problems come big opportunities,” Latimer says. 

Jennifer Kovacs Silvis is executive editor of Healthcare Design. She can be reached at jennifer.silvis@emeraldexpo.com.

For more on the 2015 Healthcare Design Showcase, check out:

Bright Ideas At Nemours Alfred I. DuPont Hospital for Children

View A Fresh Perspective At St. Charles Bend Cancer Center

Sum Of Its Parts: King Abdulaziz Medical City Behavioral Health Facility