The Center for Health Design Blog

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.

TOP A/E/C FIRM, HDR ARCHITECTURE, INC. COMMITS OVER 100 STAFF TO PARTICIPATE IN THE EVIDENCE-BASED DESIGN ACCREDITATION AND CERTIFICATION (EDAC) PROGRAM

Award-winning firm signs on to be an EDAC Advocate firm with largest commitment of design professionals to date.

CONCORD, CA (December 3, 2009) – The Center for Health Design (CHD), a nonprofit research, education and advocacy organization, and HDR Architecture, Inc., a leading national architecture, engineering, interior design and planning firm, announced today that HDR is among the first “advocate firms” for the EDAC (Evidence-Based Design Accreditation and Certification) program. As an advocate firm, HDR Architecture has committed to put a minimum of 100 of its healthcare team members through the EDAC accreditation process – the largest number of employees than any partner firm has admitted to the program.

HDR, which was ranked the #1 architectural firm in healthcare design by Modern Healthcare’s 2009 Construction and Design Survey, has 185 locations worldwide and has been a long-standing champion of evidence-based design concepts. The firm recently released a new book that explores the use of these concepts in the planning, programming and design of healthcare facilities: Evidence-based Design for Healthcare Facilities, which provides readers with the knowledge, tools, and strategies to incorporate evidence-based design (EBD) concepts into any size or scale design project. The book is edited by Cyndi McCullough, RN, MSN, director of clinical services for HDR, and includes contributions from HDR’s Healthcare Consulting Group as well as HDR clients; and is published by Sigma Theta Tau International (STTI). Proceeds are used for nursing education and research programs of STTI’s Honor Society of Nursing.

“We are excited to work with The Center of Health Design to make evidence-based design an accepted and credible approach to improving healthcare outcomes,” said Doug Wignall, AIA, LEED AP, national healthcare director for HDR Architecture. “By becoming an advocate firm, we hope to help accelerate the development of accepted EBD standards—standards that we believe are essential to the thoughtful design of innovative healthcare environments that empower our clients to heal, care, and work better.”

“Design professionals have key roles to play in continuing to push the boundaries of what constitutes a well-designed healthcare facility. EDAC champion and advocate firms, such as HDR, demonstrate a strong commitment to pushing those boundaries, which will eventually create a tipping point in the field of healthcare design,” says Debra Levin, CHD’s President and CEO. “Committing so many of its people to the EDAC program speaks to HDR’s leadership in the industry and has brought the tipping point that much closer.”

Since the exam launched in April 2009, the EDAC program has accredited over 200 individuals in seven countries across the world, and gained the backing of a diverse list of forward-thinking industry organizations, now consisting of four Advocate Firms, an Educational Partner, and six Champion Firms.

EDAC Study Guides are available to help individuals prepare for an exam, which then assesses their understanding of how to base healthcare design decisions on credible research evidence and project evaluation results. To obtain copies of the Study Guides, as well as details on testing sites, visit www.healthdesign.org/edac.

# # #

About The Center for Health Design
The Center for Health Design (CHD), formed in 1993, is a nonprofit research and advocacy organization of forward-thinking healthcare, elder care, design and construction professionals and product manufacturers who are leading the quest to improve the quality of healthcare facilities and create new environments for healthy aging. For more information, visit www.healthdesign.org

About HDR Architecture, Inc.
HDR is an employee-owned architectural, engineering and consulting firm. More than 7,800 professionals, including architects, engineers, consultants, scientists, planners and construction managers, in more than 185 locations worldwide, pool their strengths to provide solutions beyond the scope of traditional A/E/C firms. HDR Architecture is a global leader in integrated multidisciplinary design, and is world-renown for its award-winning designs of a full range of urban environments, campuses and buildings for clients in the healthcare, civic and science + technology fields. In 2009, HDR was ranked as the No. 1 healthcare design firm by Modern Healthcare magazine for an unprecedented sixth consecutive year. For more information, visit www.hdrarchitecture.com

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.