The Customer is Almost Always Right

Posted on October 25, 2012


Last week, a conversation with a hospital administrator reminded me of a group practice facility I worked on a few years ago.  The project involved fifteen specialties and twelve practices over five floors and 125,000+ square feet.  Keeping everyone happy was more than a design challenge, and design did get challenged. As my talk reminded me, the healthcare customer is always right,…but with an asterisk.

That asterisk is important because unlike many other industries where design is malleable beyond limits, healthcare is different. The situation I am reminded of was a fairly benign egress issue.  Our client wanted to limit access to and from a particular stairway in his suite. It was a contentious item each time the team met, and carried on for months. We knew the authority having jurisdiction (AHJ) would not side with our client, and we needed the design to meet code. We explained the best we could to the practice owner that design, in this case, had to bend to the “whim” of the code official.

Hearing ‘no’ is a difficult pill for some doctors to swallow. The customer simply could not have it the way he wanted it, period.

As much as a design-builder would like a healthcare client’s wishes to be granted 100% of the time without question—satisfaction guaranteed—healthcare design is such that the customer is not always #1.  Healthcare is not 

Blasphemy, you say, but it is true. Even a seasoned hospital administrator must admit, some items trump the client’s project wishes:

  1. Building codes.
  2. Regulatory reviews.
  3. Infection control.
  4. Patient and / or user safety and security.
  5. Industry best practices.

Some architects could launch a philosophical defense that evidence-based design is something that should also be unassailable to client desires. I argue there is not a consensus position on many evidence-based design items, so they are hard to adamantly defend; it is more about belief.  And, each design-build team has its own additional unique ‘lessons learned’ and internal standards that may guide design and construction decisions as well, things that they may not yield on for any reason. 

However, the above five items are things that all ethical architects and builders I know would say are non-negotiable in healthcare design, regardless of client request. They are the exceptions to an otherwise customer-centric rule that the customer is always right in healthcare.