Academic journal article Frontiers of Health Services Management

The Business Case for Better Buildings

Academic journal article Frontiers of Health Services Management

The Business Case for Better Buildings

Article excerpt

SUMMARY * The buildings in which customers receive services are inherently part of the service experience. Given the high stress of illness, healthcare facility designs are especially likely to have a meaningful impact on customers. In the past, a handful of visionary "healing environments" such as the Lucille Packard Children's Hospital at Stanford University in Palo Alto, California; Griffin Hospital in Derby, Connecticut; Woodwinds Health Campus in St. Paul, Minnesota; and San Diego Children's Hospital were built by values-driven chief executive officers and boards and aided by philanthropy when costs per square foot exceeded typical construction costs. Designers theorized that such facilities might have a positive impact on patients' health outcomes and satisfaction. But limited evidence existed to show that such exemplary health facilities were superior to conventional designs in actually improving patient outcomes and experiences and the organization's bottom line. More evidence was needed to assess the impact of innovative health facility designs.

Beginning in 2000, a research collaborative of progressive healthcare organizations voluntarily came together with The Center for Health Design to evaluate their new buildings. Various "Pebble Projects" are now engaged in three-year programs of evaluation, using comparative research instruments and outcome measures. Pebble Projects include hospital replacements, critical care units, cancer units, nursing stations, and ambulatory care centers. The Pebble experiences are synthesized here in a composite 300-bed "Fable Hospital" to present evidence in support of the business case for better buildings as a key component of better, safer, and less wasteful healthcare. The evidence indicates that the one-time incremental costs of designing and building optimal facilities can be quickly repaid through operational savings and increased revenue and result in substantial, measurable, and sustainable financial benefits.

"WE SHAPE OUR buildings, and afterwards our buildings shape us."

-Winston Churchill, October 28, 2943, speech to Britain's House of Commons

Patients and their families typically arrive at healthcare facilities under considerable stress. Unlike "want" services, such as entertainment and telecommunications, healthcare is a "need" service that, to varying degrees, patients dread. An important question for healthcare executives is whether their organization's facility compounds the stress of patients and families or helps moderate it.

Healthcare can be defined as an inseparable service because customers usually are present to receive the service performed. Just as customers must be in the taxicab to receive that service, so must they be in the operating room to have surgery. Indeed, healthcare takes inseparability to the extreme in that some customers not only visit the service "factory" but also actually live in it. Very few service industries provide beds for their customers; healthcare is one that does.

Healthcare is an intangible "product" that is used but not possessed. More than almost any other service, healthcare is highly complex and technical. The provider knows much more than the customer, and thus the customer must trust the provider to perform the right service in the right way.

Healthcare is an inherently personal service. No other service requires consumers to bare themselves as much physically and emotionally. Healthcare is also the single most important service consumers buy. If the local hardware store makes a mistake, the consequences are unlikely to be catastrophic; if a doctor, nurse, or lab technician makes a mistake, the patient may suffer great harm. Quality of life and life itself are at stake for healthcare consumers.

How do patients evaluate a service as proximate, diffuse, complex, personal, and important as healthcare? The answer is that they are especially attentive to what they can see and understand so that they can interpret what they cannot see and understand. …

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