The Power of Certainty

Posted on September 26, 2011


Two weeks ago I was zipping around in a rental car with satellite radio, a treat because of the various themed stations I rarely get to enjoy otherwise. One of the stations I spent some time listening to was the Bloomberg feed, which attempted to explain Americans’ inconsistent and fearful interaction with the stock market of late.

Investors, professional or amateur, do not like volatility, which is drastic, unpredictable behavior. Investors get nervous, and nervous investors make big moves, usually to pull out of the market out of fear. This particular interviewee reasoned that the Dow Jones average had experienced up-and-down trading swings of several hundred points a day because the American people have no certainty. A lack of certainty in the economy (jobs, consumer confidence, taxes, inflation, government solvency) was creating erratic and irrational trading behavior.

I could not help but think the story was an appropriate metaphor for healthcare, where the lack of certainty in healthcare (reimbursibles, legislation, ACOs, access to capital, insurance) was creating erratic and irrational building behavior.

Talking to healthcare administrators over the past year, I am trying to figure out why more hospitals that need new facilities are not building. The design and construction industry has heard of the supposed pent-up demand for both additional capacity and for replacing aging infrastructure, yet many projects are scaled back or still on hold while hospitals ‘wait for the dust to settle’.  In other words, they want signs of certainty before embarking on new construction.

Capital projects are a fairly insignificant percentage of an average to large hospital’s overall budget, so on some level it could be curious why such dollars are so scrutinized. No ethical architect or builder supports building for building’s sake. Maybe this is fallout from the current economic malaise where every expenditure is scrutinized:  do I really need this right now? 

Whether certainty is a significant-enough force to calm either the overall national economy’s feelings toward the stock market, or the healthcare industry’s relationship to the construction market, is up for debate. On a much smaller scale, within the modest bounds of the average healthcare project, I am happy to be a part of a system that delivers certainty—of cost, of quality, of schedule–that few others can.

It is wasted energy to worry about things you cannot control, and the actions of an entire industry or country are definitely outside my sphere of influence. I will stick to my company, and projects for my clients. And for those, a little slice of certainty is apparently just what they need.