If ever there was a time to pull on your galoshes, now may just be it. These past few months have been a roller-coaster ride on so many fronts; economically, politically, and even emotionally as we try to take stock and understand how all of these changes will impact us personally and our organizations professionally. We are surrounded by change and uncertainty. Soon our country will have new leadership in office, our financial sector is going through a massive reorganization, and institutions that have been a part of the fabric of our country for over a century have disappeared. The cost of goods and services are driving up the cost of living at a time when most organizations cannot afford to increase compensation for their employees.

There is much talk of doom and gloom in the papers and on every news channel, but I remain optimistic. I think it's much better to dance in the rain than wallow in the mud and I truly believe that buried within all of these financial challenges are opportunities to give great validity and importance to the work we are doing.

But what does all of this uncertainty mean for the healthcare design industry? What will we be saying this time next year about 2009 and the impact it had on our work? With new leadership will bring a new set of policies surrounding healthcare. Will those directives open new doors or cause a pullback in spending on capital projects? No one can argue that the economy won't take the front seat on our nation's political agenda, but healthcare will no doubt be a part of the conversation. The direction healthcare has been heading is unsustainable in the long run and will need to reform and reinvent itself. The push for public reporting of HCAHPS data will drive outcomes to the forefront of the conversation. CMS is no longer providing reimbursements to hospitals in 11 specific conditions, some of which, like falls, can be directly impacted by the built environment. And likely, new unreimbursable costs are to follow in the future.

Healthcare is being redefined and outcomes-based competition is going to be a part of the mix that consumers will begin to take into consideration when making decisions on where their healthcare dollars will be spent. With funding sources growing tighter and the bar being raised on outcome expectations from the built environment, we need to spend wisely and evidence-based research will help to guide the way. The concept of performance-based architecture holds all those responsible for making facility decisions to a much higher level of outcomes. For those who will continue to take the time to stay informed on the latest research findings, case studies, and outcome data, there will be the opportunity to impact the next generation of healthcare wherever it finds itself.

In spite of the difficult year end, 2008 has been a good year for our industry. The creativity and level of thoughtfulness that are going into the healthcare projects that I see passing across my desk and on the pages of this magazine continue to impress me. We now have a quarterly peer-reviewed research journal for healthcare environments in Health Environments Research and Design Journal (HERD). We have a new collaborative effort around workplace, environmental, and patient safety in the Global Health and Safety Initiative.

We have before us a new year and a new set of challenges, but also a blank sheet of paper and a new opportunity to create the future as we feel it should be.

From the staff and the board of The Center for Health Design, we thank you for all of your support and all of the tribulations and triumphs you share with us. You inspire us every day. HD

The Center for Health Design is located in Concord, California. For more information, visit http://www.healthdesign.org.

Healthcare Design 2008 December;8(12):10