W. H. (Tib) Tusler Jr., FAIA Planning for Health Kentfield, California

We are currently experiencing two trends that pervade the health care system and future planning. The first is the intense, relentless economic pressure of managed care. The second is the freedom from the hospital bed that our new technology has given us. It is quite likely that, in the next decade or two, our health care system will evolve into a community-based model of care with the focus shifting to prevention, early detection, and increasingly complex ambulatory care. This paper addresses the future picture for hospitals in this circumstance and the role the architect should play in planning future environments for health care, particularly hospital based ambulatory care.

Hospitals have the organizational, managerial, and financial capacity to assume and maintain the necessary leadership in the next evolution of the health care system, that of community wellness. This will only occur if providers and their architects are able to rethink their role in the health care system. Architects must design in the context of a system of care and create environments that can respond to the cost and quality issues that an efficient system of care demands.

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