Spheres of Influence

Posted on January 23, 2012


Architects have complained over the past thirty years that their significance in society—influence, status, importance—has diminished. This is largely true. I believe it has happened because of one concern: architects continue to push away risk. As architects began off-loading risk from their standard contracts decades ago and limiting services, (for instance, not accepting responsiblities and risk exposure for construction coordination like they did in the past) they marginalized themselves and their value.

Healthcare now is struggling to contain costs, and some responsibility falls on the cost of facilities—not only their hard construction costs (the costs to build them), but the ‘soft’ costs like operations (energy), maintenance, and staffing. Design affects all three of these as well as the initial construction costs of a hospital.

Facilities may not be a primary focus of hospital right now to reduce costs, at least not yet; hospitals are distracted with federal regulation compliance like electronic health records (EHR) and streamlining their care delivery models to save money and improve quality. Although as a corrolary, if healthcare architects wanted to become indispensable to hospitals they would figure out a way to assist in those areas.

Right now, the average healthcare architect can only control the container for healthcare. They can design the most sensitive exterior, and appropriate interior with a well-laid out plan and program. Everything can be clinically perfect in fact, and affordable (for argument’s sake). Currently that is where the architect’s sphere of influence ends, however. If a hospital cannot trade information timely and effectively, utilize teaming to solve complex problems, and deliver care in a smart way, the environment for the care, which the architect can affect, is useless.

Healthcare architects may want to try teaming up, in a specific design-oriented way, with the operations side—where the money is made and lost in a hospital. Take some risks:  get involved. Can an architect assist with scheduling through design? Can an architect positively assist in coding and billing? Can an architect’s design improve healthcare culture, which ultimately determines an organization’s success or lack of it?

Only a hospital CEO can touch everything in a meaningful way, perhaps, and this is internally driven. Yet architects in healthcare may want to stretch themselves to help hospitals initiate change through design in areas where design is probably not expected. No one expects a healthcare architect to be passionately driven to understand, let alone improve, billing through design. Only by expanding the sphere of influence through design can architects be the change agent and valued advisor for what everyone—patients, government, communities, hospitals—wants in the end:  improved healthcare delivery.