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The other day I said something like this to one of my clients, "In a perfect world, we would have done this project much differently."  Her response, "If you find that perfect world, let me know.  I'd like to move there."

Ha.  Me, too.  But it got me thinking. In a perfect world, what would we do differently in healthcare design?

So, here's a few ideas -- in no particular order.

In a perfect world:

  1. Every healthcare project would be designed using the 8-step evidence-based design process
  2. Evidence-based design and Lean would seamlessly integrate and support each other -- and everyone would understand how to do this
  3. Every hospital CEO and his/her board would get the value of building a better building, and commit the resources to make it happen
  4. There would be no value-engineering
  5. Major healthcare projects wouldn't take 10 years to plan, design, and build
  6. Policy-makers and government officials in Washington would understand that the design of the physical environment impacts satisfaction and safety
  7. There would be lots of money available for healthcare design research

What would you add to this list?

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Margaret Fleming

11 years ago

For me, design would not all be about architecture, except:

Every room would have some view of nature, at least the sky, SEEN CLEARLY FROM THE BED!

And every hospital room and patient or outpatient waiting room would have good furniture,including beds that help heal, not hollowed out torture beds where no one can lie on his side! If necessary, correct furniture for each size patient would be required, even if the deluxe visitor's lounge had to be sold to foot patient furniture bill.

In a perfect world, every patient (in fact everyone) would get a chair that is the correct size and shape to save his spine and leg nerves.

In a perfect world, every person in a patient's room would be taught (and supervised) to look at the actual patient and see what she may need. Like a wheelchair that a spine patient can't unlock that needs a staff member to unlock it so the patient isn't trapped.

And for every healing garden for staff and family, there must be a garden that patients actually can go into!

Jim Osborne

11 years ago

I agree with all of your seven points with exception to the fact that you say "there would be NO value engineering." I have a problem with this.

I am going to take a guess that what disturbs you most is a bad and poorly bench marked plan and design falling victim to fire drills and bad budget figures that cut very critical areas of need due to a very flawed and politically driven bid process.

I will object in favor of the case whereby the demographics and needs analysis having been performed by "ALL" of the highly qualified, fully knowledgeable and necessary stakeholders at onset (including clinical end-users), will be a "value engineered" continuing exercise as a matter of proper EBD recourse and template process.

In short, I believe your statement in #7 needs closer definition and rewording.

As for additions to your narrative, I also believe that proper and most effective EBD practices require constant perfection of LEAN / Proven/ Best Practices templates by category (ie; ACC, ED, Community Hospital, Micropolitan Health Center, Cancer Center , etc...) as a means of maintaining highest quality duplication of minimum standards in planning and design outcomes.

On this note it would appear that nothing seems to be more valuable than the one year post-occupancy evaluation of performance......Lessons learned.

This is an excellent initiative.

Sara Marberry

11 years ago

You are correct in your assumption about what I don't like about value engineering. I knew when I wrote it that some forms of value engineering aren't bad, and are necessary for most projects. Maybe it's the term "value engineering" that I don't like.

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What's my story? I'm a healthcare and senior living design knowledge expert who writes and speaks frequently about trends and issues affecting these two industries. I'm also a strategic marketing consultant and content creator, working with companies and organizations who want to improve the quality of healthcare and senior living through the design of the physical environment. You can reach me at .

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