Henry Ford is widely believed to have said of his Model T, “You can paint it any color, so long as it's black.” Would that construction projects were so easy. The design guru from “On High”—an architect, a facility planner—says, “It shall be thus!” And, lo and behold, that's exactly how the project turns out.

Now for a reality check. I remember when I, as a construction project neophyte, assumed that building a hospital or other structure was a fairly cut-and-dried deal. You had your plans drawn up on paper, they were presumably agreed to by everyone, and then professional builders came along and simply followed the plans in putting the building up. Then I began hearing words like “change order” and “value engineering.” And I wondered, “What is this? What happened to my orderly process?”

What happened, of course, was that reality intruded. Maybe a contractor had his/her own pet process and wanted to teach the young designer whippersnapper a thing or two. Or the contractor discovered something—a site feature, a technical complication—that made the structure as designed all but unbuildable. Perhaps facility ownership or management brought in new people with “new ideas.” Or existing ownership/management read or heard about some new design feature that they just had to have. Or medical technology, as is its wont, had evolved rapidly and radically enough to call for entirely new space and other arrangements. Or maybe something ended up being just too darned expensive.

So it was with interest that I read a number of article submissions that have come in of late focusing on restoring order, or at least more order, to the healthcare design process. You'll see some of these pieces in this issue and the next, using such terminology as “operational analysis,” “process mapping,” and “construction detailing activity,” which I gather is a subset of “coordinated construction management.” You'll learn that a professor of civil and environmental engineering, Glenn Ballard, PhD, of the University of California, Berkeley, is leveling full academic firepower on what he calls “Lean Project Delivery Systems” for healthcare design.

The gist of all this is that all parties involved in developing a project—architects, designers, planners, owners, staffers, and patient representatives—must communicate faithfully and regularly with each other from Day One to keep things on track, avoid nasty surprises and, in general, complete the project as smoothly and efficiently as humanly possible. (Notice the word “humanly”; as with any human endeavor, there will be bumps in the road—although the process devotees tell us that these, too, can be good if discussed thoroughly.)

As one who recently worked for a small company that we affectionately referred to as “Medquest Mis-Communications,” I've experienced the difficulties of communicating even among people on the same corridor. But that's all the more reason for me to applaud and respect the efforts of those working to organize the healthcare design process. It seems like such an obvious prerequisite. Who knew it would take so much hard work? HD