Wayne Fishback, AIA
Fishback & Associates
Simi Valley, California

Alan Shubin
TPG, Inc
Rolling Hills Estates, CA
Former CFO, City of Hope National Medical Center
Duarte, California

A Proclamation of Need
A recent article in Health Care Strategic Management magazine by Cynthia Hayward, is a wake up call for healthcare architects to seize the initiative and lead the charge of right sizing the hospital for the next millennium. A synopsis of her points best illustrates the need:

•	"Because so much has changed in just the past decade-particularly with 180-degree shifts in popular trends and financial incentives-it is not surprising that we have so many inappropriate and unnecessary health care facilities."
•	"Historically, the facility planning process focused on the wish lists of physicians and managers and often ignored the impact on operational costs and relevance to strategic planning initiatives. With design architects often leading the planning effort, there was little incentive to look for creative ways to avoid overbuilding."
•	"With double digit inflation, confusing legislation and building codes, and easy access to capital, aggressive architects and contractors convinced hospital leaders that it was cheaper to build surplus space, and let it sit empty until needed, than to postpone construction."
•	"A more comprehensive facility planning process is needed to ensure that alternate ways of allocating resources are thoroughly evaluated, and that the impact on operational costs is fully understood, prior to spending money on bricks and mortar."

Ms. Hayward's diagrams of the "comprehensive facility planning process for multi-hospital systems" calls for "setting benchmarks and monitoring long-range facility needs." After first reading this article, I was quite disappointed with Ms. Hayward A.I.A., a colleague of mine for almost 20 years. How could she so blatantly attack our shared professional community of architects. After some reflection, however, I found myself agreeing with almost everything she was saying. There were, however, some gross over generalizations in her finger pointing and criticism of architects.

The fact is that the majority of space programming has been done by hospital consultants and not architectural firms, over the past 25 years. Architects have gradually relinquished this role to a category of specialized professionals known as Hospital Consultants. On balance though, she correctly identified price competition as a "sea" change in the healthcare industry. She further described a number of conceptual remedies as it relates to healthcare facilities being adapted to this new environment.

Missing, however, were identified and quantified benchmarks in Ms. Hayward's solid documentation outlining the current state of affairs in hospital space planning. True, there was a reference to the quantity of excess beds correlated to excess space. But this provides little guidance to the hospital planner, trying to establish the detailed numeric programmatic needs, for a hospital facility that will be responsive to a healthcare environment of relentless cost cutting and price competition.

Abstract

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