April 19, 2007

Change is coming. Are designers ready?

  • Regulations, technology, economics and the environment lead a list of issues for designers to tackle
    Taylor Gregory Butterfield Architects


    Health care is a rapidly evolving industry. As a result, health care architecture, construction and the retailing of health care services are quickly changing as well.

    The further out we look, the more varied and shifting the topography becomes. We, the design professionals, now more than ever must be cognizant of the many factors affecting our clients and their clientele. Within this year alone we anticipate that we will see a shifting of legislation, design standards, consumer trends and technological advances.

    Legislative changes

    In 2007, the state of Washington plans to adopt the American Institute of Architects guidelines for health care design in lieu of the Washington Administrative Code.

    This adoption of new design criteria and guidelines represents a significant change. The most significant impact may very well be the recommendation for the use of only single-bed patient rooms in acute care facilities.

    How will the new guideline for single-bed patient rooms affect reimbursement, the quality of care and staff efficiency?

    In 2007, we reach the sunset of the current Washington legislation that allows a public body to utilize the general contractor/construction procurement and delivery method for public works projects valued at over $10 million.

    This legislation has allowed public entities, including public district hospitals, the opportunity to take advantage of early bidding as well as to select and negotiate a maximum allowable construction cost.

    The March 2007 issue of Architectural Record indicates that alternative delivery methods of construction, which allow owners to have better assurances of quality and control, are the wave of the future. The GC/CM procurement and delivery method appears to have taken hold, prompting many to anticipate that legislation will be enacted to renew or enhance the process currently in place.

    The result of a sunset of this current legislation without a mechanism to launch similar or enhanced methods of delivery would be detrimental to the public entities in the health care industry. Without opportunities of alternate delivery methods, public entities, such as public district hospitals, would once again be exposed to less than favorably qualified competitive bidders and to factors associated with high-risk change orders during construction of competitively bid projects.

    In such projects, bidders win by coming in with the lowest competitive and qualified bid, only to recover the costs necessary to actually delivery a quality project through arduous and potentially adversarial change order process.

    How can we, as professionals, protect our clients from these potentials?

    More sustainable design

    In 2007, we will expect health care organizations to not only scratch the surface, but to dive head-on into energy efficiency and sustainable design.

    The highly labor-intensive LEED certification may not be the only avenue for conscientious and responsible design efforts. The High Performance Hospital Partnership, a collaboration between Northwest hospitals and health care associations, and BetterBricks, the commercial program of Northwest Energy Efficiency Alliance, aims to improve energy efficiency of hospitals, increase operating margins, reduce operating costs and support the healing environment.

    In the same vein, the Green Guide for Health Care is a superb resource. It helps the leaders and managers of health care institutions “walk the talk,” promoting the health of patients, visitors, employees, community members, and the global community while operating economically and efficiently.

    Health care facilities present both a challenge and opportunity in the development and implementation of sustainable design, construction and operations practices. Issues such as 24/7 operations, energy and water use intensity, chemical use, infection control requirements and regulatory requirements can pose significant obstacles to the implementation of currently accepted sustainability protocols. The Green Guide for Health Care supports health care organizations as they wade through these challenges and obstacles.

    Revolutionary boomers

    Educating our clients about green options is our responsibility. Where does our responsibility lie when our desire to make buildings sustainable and environmentally responsible conflicts with the desires of our clients?

    In 2007, technology changes and baby boomer expectations will continue to shift and alter our environment and the planning of facility improvements.

    Baby boomers have not only led the way for consumerism in health care services, but have also left their mark on history as the generation of revolutionary ideas. Microchip processing, fiber optics, robotics, Internet, wireless communication, microwaveable food, CDs, MP3s, artificial hearts and limbs and outpatient surgeries all are products of this generation’s revolutionary efforts and influences. It is no surprise, that as baby boomers look to impact health care systems, they will do it in a revolutionary way.

    Finding, defining and accommodating those ways will rest heavily upon our design efforts, skills and creative talents in the coming year.

    Economic forces

    And what is to become of our changing workforce in health care? How will the skyrocketing liability insurance costs affect the attrition rate of physicians? How will the aging population of nursing staff and the downturn in nursing school enrollment affect us in the coming year?

    In 2007, the health care industry will continue to change at an exceptional pace and the economic issues associated with that change are both powerful and dynamic.

    Medicare/Medicaid reimbursements, the uninsured, strategies to reduce the number of uninsured, consumer-directed health care, changes in the nature and intensity of competition for patients and services, changes in technologies and other issues related to credit and financing will all dramatically affect decision-making.

    In 2007, our clients will look to us to understand and interpret these critical economic forces shaping health care today and in the immediate future. They will look to us to interpret how their organizations might anticipate and react to such forces to assure continued financial health and performance.

    They will look to us to assist them and to provide them with facility master planning and facility design services that address those essential concepts and to establish best practices in health care delivery and financial performance.

    In 2007, as always, our clients will look to us. The only question remaining seems to be, “How prepared are we?”

    Lois Broadway is a principal with Taylor Gregory Butterfield Architects, a firm specializing in health care planning and design.

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