The Center for Health Design Blog

Rebound for HC Design & Construction Industry?

Well, here’s some good news. Modern Healthcare’s 2009 Construction & Design survey indicates that things are coming back, but probably won’t hit full stride until late 2010.

Buoyed by spending by the U.S. federal government on VA and Department of Defense hospitals, the survey reported 3,086 projects costing just a little over $66 billion were designed in 2009. Another 1,864 projects costing $38.7 billion broke ground and 2,944 with a price tag of $33 billion were completed.

While some healthcare architecture firms, such as top ranked HDR, had record breaking years, many felt the competition from firms not traditionally involved in healthcare. This is not surprising, but given the specialty nature of healthcare design, the buyer better beware.

Other interesting things in the MHC report are some building trends cited, such as focus on flexibility, smooth workflow, green construction, and evidence-based design (described somewhat accurately as something that “aims to create a healing environment while promoting patient and staff safety”). A two-year $55 billion government stimulus plan in Canada also helped some of the larger healthcare architecture firms grow their business.

If you are a subscriber to MHC, you can read the report in the March 15th issue. PDFs of the report and charts can be purchased at the Surveys, Lists, and Data section of its website. Or, reprints of the published report can be ordered by calling 800-290-5460, etx. 125 or sending an email to modernhealthcare@reprintbuyer.com.

Update on GHSI

Recently, the decision was made to conclude the activities of the Global Health & Safety Initiative (GHSI) and dissolve the current organization. Formed in October 2007, GHSI was a network of leading health systems and other health partners that were committed to championing and implementing a sustainability and safety agenda within their health systems and communities.

The founding health systems and partners remain committed to the goals of GHSI, but they determined that there were more efficient and effective ways to achieve sector-wide leadership — particularly in light of today’s economic and political climate.

So, the plan is to fold the work into Health Care Without Harm (HCWH) and its sister organization, Practice Greenhealth (PGH), and make it an initiative of HCWH. This yet-to-be named initiative will continue to focus on patient, workplace, and community health and safety, but will focus more on the impact environmental sustainability has on patient and occupational safety.

The Center for Health Design is planning to continue to be involved in this initiative, as we believe there is a natural link between the evidence-based design process and sustainable building design — particularly as it relates to safety. For example, toxins and resource consumption can be reduced by choosing the right surface materials, air-handling systems, water processing systems, and lighting. In turn, research has shown that many of these design choices help decrease falls, infections and errors.

In the meantime, there are lots of good resources on sustainability and safety the GHSI document library, which will remain live until March 31. Check them out and watch this blog for more information on the “new” initiative.

Communications/AV Expert Critical to LTC/Senior Living Projects

This past weekend, I attended the DESIGN: Environments for Aging architectural showcase issue judging in Dallas. Published by Long Term Living magazine, this annual review is a collaboration between SAGE, The Center for Health Design, ASID, and the Vendome Group (publishers of LTL).

At the end of the judging, there was a roundtable discussion in which we talked about a variety of trends and features common to many of the 40 project submittals. (These folks were architects, interior designers, developers, owners, regulators, and other consultants to the long-term care/senior living industries.)

I found the discussion about integrating technology and facility design fascinating. Everyone in healthcare is dealing with it, but in long-term care/senior living facilities, the needs are a bit different. Not only do you need to plan for things like nurse call systems, electronic medical records, and motion sensors, but also for personal computers, sound systems, televisions, DVRs, gaming systems, telephones, etc. — the stuff that all of us have in our houses.

Now I don’t know about you, but anytime my husband or I have to figure out something like setting up a new television or connecting all our devices to a wireless network, it’s complicated. We most always call in an expert. And apparently a new breed of expert — a communications/audio visual consultant — is starting to emerge in long-term care/senior living to deal with all the technology that has to be integrated into these facilities.

One gentleman shared a story about a client who, in order to run a wire through a tight space, brought in a small dog, attached a wire to him, put him into the tight space, and called his name at the other end to run the wire. So actually what you need is a communications/audio visual consultant with a small dog.

All kidding aside, my point is that architects and designers aren’t experts in technology, just as they aren’t experts in landscape or lighting design, or art. So it makes a lot of sense to bring in a communications/audio visual consultant at the very beginning of the project to be a part of the team. Vendors may be able to help with some of it, but it’s the integration of all of it that requires one expert.

It also makes a lot of sense to budget for all of this stuff, especially the personal technology piece — because this is going to be a growing area of importance to the next generation of seniors who will be living in these facilities. And the next generation of seniors is my 75-year old father who has an iPhone, laptop computer, HDTV, DVR, and Playstation.

Hospitals Under Attack for Spending Money on Capital Projects

The front page of today’s Chicago Tribune has a huge picture of a building under construction at Rush University Medical Center, accompanied by the headline, “Big hospitals flush with cash despite industry’s dire warnings: Critics say large hospital operators that are amassing cash are doing so at the expense of patients.”

The article goes on to point all the major hospital systems in the Chicago area that are undergoing new building projects and buying up other hospitals. “Many are spending unprecedented amounts on new buildings and seeing some of their best improvements in cash since the dot-com boom of a decade ago,” writes reporter Bruce Japsen.

I agree that it may seem out of balance with the financial pressures that hospital industry lobbyists are telling Congress, not to mention the millions of uninsured people in this country. But the argument that hospitals and health systems should not make capital improvements and instead provide charity care or reduce the cost of care is a little short sighted.

There are a lot of reasons why hospitals and health systems decide to replace or renovate buildings, but mostly this is happening because their facilities are 40+ years old, more costly to operate, and don’t support current technology. By investing in new facilities, most are creating healthcare environments that are more efficient, safer, and less stressful for both patients and staff. (Using research and data from actual facilities, The Center for Health Design has made the business case for building better buildings.)

It doesn’t cost the patient any more to visit a brand new hospital vs. a 50-year old one. But it does cost the hospital or health system more to own and operate a 50-year old hospital vs. a brand new one. And most likely, all the projects the Tribune article mentions were financed and set in motion 5-8 years ago. Is it fair to point the finger at them for making decisions before the economic downturn even existed?

Lessons Learned From Iconic Hospital Projects

For the past several years, Kirk Hamilton, Don McKahan, and now Frank Pitts have been doing a presentation at the HEALTHCARE DESIGN conference on the important lessons learned from the most innovative and groundbreaking healthcare facilities of our time.

It’s a great presentation, because these guys actually go and visit the facilities, take their own snapshots, and interview the client and the architect. This year they looked at the Ambulatory Clinical Building at M.D. Anderson Cancer Center, Dartmouth-Hitchcock Medical Center, and the MacKenzie Health Sciences Centre.

What struck me, though, as I listened to them talk last month, is that because they are all architects, they focus mostly on the programming and planning aspects of the building itself. Granted, it’s only an hour presentation, but there was a lot about the architectural elements of the building and very little about the interiors.

So, I think it would be great for three prominent interior designers to do the same type of presentation, but focus on the interior design innovations that have stood the test of time and become part of evidence-based design thinking. Perhaps they could even re-visit some of the past “icons” that Hamilton, McKahan, and Pitts have reviewed and/or collaborate with them.

If you’re interested in pursuing this idea, submit a proposal to HCD10! Deadline is Friday, January 22.

The Glass is Half Full

According to a recent article in Modern Healthcare, hospitals reported $26 billion less in profits in 2008 than in 2007. The biggest reason for this loss was because their investment income sharply declined as the stock market tanked in the last half of 2008.

And, although the equity markets have been rebounding lately, many hospitals are taking steps to improve their performance so they can create more capital through operations rather than relying so much on investment income. Access to capital is also improving, as investors have started to funnel cash back into municipal bond mutal funds.

I’m not a financial expert, but it seems to me that this is all good news for healthcare facility construction. Hospitals are going to need to continue renovating and building new buildings and they will need to find the money somewhere to do it.

It also means that the business case for building a better building is even more important than ever before. By using an evidence-based design process, if you can build a facility that helps improve an organization’s performance, that is a win-win situation for everyone.

Cramming for the EDAC Exam

A few weeks ago at the HEALTHCARE DESIGN.09 conference in Orlando, FL, 38 individuals sat for the EDAC exam. Space was limited to 40 and if we’d had more room, we probably could have doubled that number.

Some people had been reading the study guides and cramming for weeks, others attended the onsite study workshop on Sunday and pulled an all-nighter reading the study guides before sitting for the exam on Monday. One person told me that he didn’t study at all and was just taking the exam cold.

Probably our risk-free offer (take the EDAC exam and if you don’t pass, you can re-take once for free) helped spur these individuals to take the plunge. But since the exam launched in April, about 200 individuals have taken and passed it.

Does that automatically mean they know everything there is to know about evidence-based design and have projects to show for it? No. But it does mean that they understand how to design and build a healthcare building using an evidence-based design process. In that sense, EDAC is definitely establishing some industry standards for competence and knowledge.

So, if you’re ready to take the EDAC exam, the risk free offer is still on the table — plus a 10% discount. All you do is submit your application to take the EDAC exam between November 6 and December 31, 2009, use code HCD09, and if you don’t pass you can re-take the exam once, for free.

You have six months to schedule the exam once your application is processed. However, only applications received by the end of the year are eligible for the risk free offer and discount.

If anyone out there reading this has taken the EDAC exam, please comment about your experience! Was it hard? Easy? How did you prepare? Were there any questions on the exam that you just didn’t know how to answer?

Barriers to Change

I attended a meeting the other day of a group of volunteers assembled by The Center for Health Design with support from the Hulda B. and Maurice L. Rothschild Foundation. Our task was to have a discussion about the long-term care guidelines for the design and construction of healthcare facilities and see where we could identify areas for changes or additions.

Rob Mayer of the Rothschild Foundation told the group that the question they are always asking about long-term care is “What are the barriers to change?” In terms of the built environment, the answer is usually, “regulation.”

Some of the organizations with representatives at the meeting included Planetree, the Pioneer Network, Facilities Guidelines Institute, Society for the Advancement of Gerontological Environments (SAGE), and several architecture and design professionals who are actively participating on the guidelines revision committee. Here’s some of the interesting comments I heard throughout the day:

“Person-centered care is person-centered care no matter where you are on the healthcare continuum.”

“Wonderful stories [about elders in long-term care settings] don’t create change.”

“We’re not nursing home abolitionists, because there are still a lot of people living in those places.”

“Acuity-adaptable settings — healthcare provided where people live — is a new way of thinking about assisted living and long-term care.”

Look for more to come from this workgroup, which plans to draft a series of white papers and comment on the next round of revisions for the guidelines.

Happy HEALTHCARE DESIGN

The HEALTHCARE DESIGN.09 conference starts tomorrow in Orlando, FL. Every year, I look forward to this gathering of our industry — seeing old friends, making new friends, checking out the latest and greatest healthcare products, and finding out the latest ideas and thinking about designing healthcare buildings.

It’s a packed four days, and for me, much of it is spent meeting with our partners, volunteers, and other supporters of The Center for Health Design’s work. We’ll have a booth near the conference registration area, so if you’re attending conference, please stop by and say hello to our staff and learn more about the work we’ve been doing in 2009.

There are also several educational sessions and roundtable discussions on our EDAC (Evidence-based Design Accreditation and Certification) program and various research projects. Many of the partners in our Pebble Project research initiative are also presenting. (Go to this page on the EDAC website to download a PDF of Center and Pebble Project related sessions.)

I’ll be tweeting from the conference and hopefully will have time to do a few blog posts as well. See you in Orlando!

Accreditation or Certification: What’s the Difference?

Recently, Planetree certified five architecture and design firms as part of it’s new Visionary Design Network. According to its news release, this certification “establishes these firms as specialists in evidence-based healthcare design following the Planetree philosophy and its core components of healing design; such as welcoming a patient’s family and friends, valuing human beings over technology, enabling patients to fully participate as care partners, and fostering a connection to nature and beauty.”

I think this is a great way for Planetree to recognize design firms that have successfully implemented the Planetree philosophy and help promote evidence-based design. To ward off any confusion in the industry, it is important to note that the process it is using to qualify these firms as “specialists in evidence-based healthcare design” is different than EDAC accreditation.

To apply for certification and become part of the Planetree Visionary Design Network, candidates fill out a self-assessment tool that includes a section on evidence-based design. They answer questions about their firm’s experience using evidence-based design research; whether they have utilized resources from The Center for Health Design, EDAC, Environmental Design Research Association (EDRA), or other research-based organizations; published results; and how they have used research to inform design projects.

Once the application is reviewed and accepted, interviews are conducted with firm principals, followed by a project site visit by representatives from the Planetree Design Advisory Council. If all goes well, firms are certified and become part of Planetree’s Visionary Design Network.

EDAC accreditation, on the other hand, involves educational training in which candidates learn about the evidence-based design process, and then take an exam to test their knowledge of that process. The exam, which was developed by a diverse group of industry professionals with the assistance of a psychometrician (experts in developing multiple-choice questions for qualifying a certain level of knowledge) is administered by a third party.

Design firms who commit a certain percentage of their healthcare team to study and take the EDAC exam are being recognized as EDAC Advocate Firms. Those who took the beta test are EDAC Champion Firms.

As best as I can tell, in the design industry, certification means a person or entity conforms to the requirements specified in a certain standard. Accreditation is formal recognition by a specialized body of a certain level of knowledge. In this sense, Planetree certification and EDAC accreditation can support one another.

The American College of Healthcare Architects and the American Academy of Healthcare Interior Designers offer certification programs that refer to evidence-based design principles, but do not focus on teaching the evidence-based design process. They are also different from EDAC in that they are specific to the architecture and design profession.

The National Council of Interior Design Qualification (NCIDQ) and National Council of Architectural Registration Boards (NCARB) test knowledge of architectural and interior design practice and are required to become members of professional associations such as the American Institute of Architects and the American Society of Interior Designers — as well as become registered architects and interior designers. To my knowledge, there is nothing on those exams about evidence-based design.

And of course there is the U.S. Green Building Council’s LEED program, which accredits individuals on their knowledge of sustainable design principles and certifies green buildings. There are clear intersections between eco-effective design and evidence-based design for healthcare, but I’m not sure this is addressed in the LEED examination either. Like EDAC, LEED accreditation is open to more than just architecture and design professionals.

I’m also aware that there are many, many other accreditation and certification programs for healthcare professionals, but that’s a horse of an entirely different color.

What do you think the difference is between accreditation and certification, and the various programs I’ve mentioned here?