HKS, Inc.
With hospitals currently spending billions of dollars annually on new construction and remodeling, it is increasingly important for healthcare industry leaders to view their dollars as an investment that yields measurable results. This applies to the clinical, environmental, and financial aspects of their operations. In order to create the interaction between space and people that results in a progressive outcome, the healthcare community is paying special attention to evidence-based design (EBD), in which the expected outcome of a spatial design intervention is confirmed or rebutted by research-derived data. An increasing body of data confirms the effectiveness of incorporating EBD concepts into the built environment, yielding improvement in patient, visitor, and staff well-being, safety, utilization, productivity, and clinical results.

Studies commissioned through The Center for Health Design demonstrate that the potential up-front added cost associated with the incorporation of EBD concepts is outweighed by the benefits. Examples include reduced medical errors and nosocomial infections; fewer patient accidents; increased patient, visitor, and staff satisfaction; increased operational efficiency; and reduced obsolescence.

In the quest for heightened clinical benefits and improved fiscal performance in the built environment, selecting a consulting design team is critical. We firmly believe in an objective approach to evaluating the suitability of design professionals based on multiple measurable criteria, including EBD, and advise our clients to do this. In our approach, the organization and execution of this comprehensive and objective selection process is based on four steps: Request for Qualifications (RFQ), site visit, Request for Proposal (RFP), and interviews of key team members.

The RFQ, an educational tool that reveals pertinent information about the design firm, confirms the firm's interest in pursuing the project and collects information about the firm's relevant expertise, regional/marketplace experience, and the personal experience of specific team members. It also reveals how much collaboration with other firms is needed to provide the desired scope of work.

To evaluate the information in the RFQs, our clients use a detailed summary and often a scored matrix that represents an objective analysis of the responses. We urge our clients to review the RFQ responses relative to EBD, noting the architect's knowledge of emergent research and established data. The architect's EBD-related knowledge includes not only the spatial quality of the design but also clinical outcomes, financial performance, economic advantages, and patient, visitor, and staff satisfaction. Through examples based on this knowledge, the architect should be able to demonstrate creative ways to apply the tested concepts to the specific project.

An evaluation of the firm's expertise will determine whether it concentrates on specific areas of EBD, such as environmental and social interventions, or whether its background encompasses all areas of potentially measurable outcomes, including technology, clinical outcomes, sustainability, and employee performance. Also, clients will gravitate toward firms that, beyond the qualifications already established, are able to share the design and data with the community and work closely with researchers to evaluate the data in an objective manner while measuring postoccupancy outcomes. These firms publish articles, belong to the research community, and have experience in public speaking on relevant subjects at industry conferences.
Walter R. Adams

The second step, a site visit, provides at least four major benefits. First, it offers the invited firms an opportunity to experience the community and tour the site. Second, it gives client leaders an opportunity to describe their organization and goals in their own words. Third, each firm can demonstrate its understanding of the project, probing further for underlying issues and describing how its approach would meet the client's needs. A fourth advantage of this face-to-face interaction is the client's ability to observe potential team members “in action” and consider how these individuals might interact with physician leaders, board members, etc.

We recommend using an abbreviated confidentiality agreement before sharing sensitive information and key statistics in these visits. And we often present the client with interview questions designed to uncover information not included in the RFQ response or clarify information the RFQ contains.

In the third step, qualified firms are invited to respond to a Request for Proposal (RFP). This detailed document describes the desired services, schedule objectives, deliverables, and other key success indicators important to the client. Each firm has an opportunity to describe its unique business approach, process, and staff expertise that might accommodate those desires. Work schedule confirmation and a detailed summary of proposed fees are also provided in the RFP, which should also indicate the amount of time key team members will dedicate to the project. The client then receives a summary and comparative analysis of the various RFP responses.

Because more than one firm may satisfy the competency standards described in the RFP, the fourth step, a face-to-face interview of key team members from each firm by the client's selection committee, is essential. An informal, conversational “work session” is the best environment for observing the chemistry between client and architect. A thorough selection process also includes reference checks on the firms and their proposed team members. Site visits by the client to similar completed projects allow the client to experience the firm's work firsthand and discover how satisfied or dissatisfied the previous customers were with the firm's service and finished project.

Selecting an architectural firm is an important and long-reaching decision, which is why we advise our clients to allow plenty of time to make the final choice. The selection process is not concluded until the negotiation of the formal agreement is executed; success is realized when the client executes the “right” agreement with the “right” firm, aligning the interests of both entities.

This thorough and rigorous process ensures the selection of an architectural firm that meets the client's requirements for both competency and “chemistry.” It requires a significant commitment of time, but our clients are rewarded when they select the architectural firm that meets their key criteria of scope, values, budget, and culture, and is altogether best-suited for a successful partnership. A successful partnership thrives in the knowledge that the members' common expectations have been met and even exceeded, and that the benefits derived from it touch all involved in designing, delivering, occupying, supporting, and maintaining a healing environment in the new facility. HD