World-Class Design: A Run in With a Ferrari

Posted on March 10, 2014

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I listened intently to the Director of Planning, Design and Construction and how his healthcare system was preparing to roll out a new Children’s hospital.  This Director, for a system known for innovation and above-average industry performance, was lamenting how his new Children’s hospital would open and likely need renovations within 60 days.  “I bet my next paycheck on it.”  The Director sounded powerless, as if this was a train wreck he could see coming but could not prevent.  It was my most disheartening conversation with an administrator in recent memory.

How could a new hospital, with the freedom of a clean sheet of paper, a healthy budget, and plenty of time to develop the design, open and immediately be, in some form, either inefficient or obsolete?  Reality check:  this is not the latest smart phone we’re talking about.  It is a hospital, with an expected useful life of 40+ years.

For him, somewhere the implicit blame lay between knowing what is needed (program), design development (process), and the departments (users) who would ultimately ‘accept or not accept’ the final product.  And this is a story from a successful healthcare system.  I wonder what it is like with hospitals with far more limited resources, with less corporate leadership and coordination?

Contrast this with an event last summer.  I was in my hometown of Williamsport, Pennsylvania and noticed a Ferrari parked outside the grocery store.  A Ferrari in Williamsport?  It may as well have been a unicorn.  So I parked near it to admire.  As it turned out, the owner was approaching his Ferrari when I was done with my shopping.  I complimented him on his gorgeous car.  It looked brand new, so I asked how old it was.  He told me to guess.  I looked again, and recognized the trap.  I immediately recalibrated in my head and aimed lower.  “A 1993?” I surmised.  “I bought it used.  It’s a 1979.”  [Me:  slack-jawed].  It’s 2013; I’m looking at a car that was more attractive than 99% of new cars on the road, and I couldn’t even guess its correct decade of origin.

If Ferrari put that much effort into the outside design—that much effort into imagining how a car will need to look and function 35 years in the future and not appear obsolete—then I wonder what kind of other world-class ideas were buried in this beauty?  Steering? Engine? Cockpit?  What was Ferrari thinking when they dreamed up this design?  How did the design and engineering teams debate and decide, and then reconcile with the hand-crafters that built it?  How could they envision and design (and engineer and build) for the future so successfully?

Think about all the things we interact with every day, from our clothes and frying pans to our toothbrushes and buildings.  How many objects can we say are world-class in design, innovative now and serviceable if not still innovative in five, ten, twenty years?

Today, world-class healthcare design is not defined by stainless steel or an expansive atrium.  It’s not LED lights or a fresh color palette.  I have been in hospitals that worked like a Swiss watch and hid their age, and have seen others who appeared much older than they actually were.

World class design is a little bit of aesthetics and a lot of what’s under the hood.  In healthcare design, that means an obsessive attention to the mechanics of clinical operations—how people move and do their jobs every day to deliver care—and how that might change in the future.  It means having the courage to set design ahead of a particular (influential) administrator’s wishes because you know the building will function worse if the layout is compromised.  It means using technology and research—exhausting every possible resource—to inform every decision now, and then imagine what the future will be, and design for those needs, too.

Make no mistake:  world-class healthcare design is incredibly difficult.  It is the exception, not the rule.  Choose your design (and engineering and construction) team wisely.

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