Last week I attended the 2011 ASHE Planning, Design and Construction (PDC) Healthcare Summit, a large annual meeting for healthcare designers, engineers, facilities directors, and administrators.

I can only be in one place at one time. With that in mind, it is difficult for me to summarize an entire conference because it is biased toward the sessions I attended, the conversations I heard, and the people I met. Yet, every PDC seems to have an unofficial theme running through it. Three years ago it was "green," two years ago "BIM," and in 2010 it felt like "Lean." This year, I have to say it was "more with less." Here is what I gathered during my three days in Tampa:

  1. Efficiency. This popped up in sessions on commissioning, LEED, and ASHRAE standards, among others. If there was a time to do more with less, it is now—to make sure what you have purchased for your hospital and use every day is running like it was designed. I attended a session called "Finding Hidden Assets," which was a good discussion on how to find duplicated, underutilized, and dislocated space. This would cost much less than new construction to recapture, and allow capital projects budgets to stretch farther. There was also a session on expansion vertically, for those short on real estate who also want to do more with less.

  2. Integration. Integration showed up a lot. From sessions on Integrated Project Delivery to several discussions on how hospital care will need to integrate internally (heard at least a half-dozen times), there is a clear belief in the design world that more things can and should be working together for better outcomes. Lean design could also fall under "efficiency," but I see it as an integration issue. Lean showed up quite a bit last year, and also in a few sessions this year.

  3. Information technology. With so much emphasis on IT in the healthcare legislation (now going on one year old), I am not really surprised it was as prevalent as it was at the conference. People have had a year to digest the requirements and start to make sense of them. Nevertheless, IT was everywhere in sessions: Electronic Medical Records, IT integration, data centers, the "IT Tsunami," and all the talk on healthcare legislation fallout. One of the closing plenary sessions was entirely focused on the “HITECH” component and what electronic health records will mean to hospitals.

  4. The business of healthcare. More than ever, designers need to understand to the best of their abilities, how hospitals make money and why, or why not, certain design decisions should be made. Even though healthcare administrators know their business best, architects and engineers need to ask the tough questions of their clients—even if just to confirm decisions on the owner's end that have been thoroughly researched and discussed in private. In addition, new trends show the creativity of healthcare manifest in bricks-and-mortar, such as freestanding emergency departments, and also made it into sessions.

  5. Energy. If it was not an overtly LEED-themed session, energy popped up more obviously elsewhere. I attended a session on ASHRAE 189.2 and much to my surprise, it turned out to be more about holistic green design than an energy standard update. Add to that sessions on Standard 90.1 and commissioning, and it was clear that saving energy was a way to do more with the less efficient existing infrastructure at hospitals.

For me, there were some conspicuous absences: evidence-based design and BIM. Some topics have a short shelf life at conferences, and it is not clear when other topics hit their peak frenzy. Evidence-based design was more present last year and surprisingly absent in 2011, save for a session or two. I hope to hear more on this topic, and from new angles. Likewise with BIM. Maybe adoption is pretty significant in design offices these days, but the list of programs that run "through" or "overlaid" on BIM, which enhance BIM's utility, is expanding. And it is pretty hard to keep track of it all. Just the software can be a discussion in itself.

Unlike last year's collective psyche, which was depressed due to the economy yet charged with tension from impending legislation, I felt this year was more upbeat economically but still anxious because 95% of the attendees have no clue how to design for the economic consequences from what is going to happen in the healthcare industry. We heard some heady stats on expected mergers and acquisitions, as well as significant percentages of hospitals that are expected to go out of business. It is almost as if healthcare architects are field medics waiting for their clients, the hospitals, to go to war. Only when the dust settles and the medics take stock of the annihilation will they see if their owners survived will they be able to react. We know changes are coming in the industry; however, the magnitude is anyone's guess.