The first of a two-part series on how well-conceived RFPs can stimulate cutting-edge concepts in response by Jens Mammen and Anne Belleau-Mills, AIA

The request for proposals (RFP), the document that kicks off most healthcare construction projects, conjures few positive images. Many see it as a formality, a necessary evil obstructing the main event: the building. This is dangerous thinking. Whether it is the first impression or the critical first step, the RFP sets into motion the potential for success. Building has big consequences—hospital construction costs are pushing $400 per square foot in some regions—and RFPs bear heavily on ensuring money is well spent. Operating costs loom larger still. Thus, the RFP establishes whether a facility is intended as mere shelter or as a platform for process innovation and world-class care delivery.

A large A/E firm may get 10 RFPs per week and only take action on 50 or more per year. Those RFPs illustrate a transformation now sweeping perhaps 70% of the healthcare field: Clients are looking for ways to re-engineer, both from a business and care-delivery perspective. Therefore, they want documented examples of how cutting-edge concepts such as lean operations, quality integration, and evidence-based and green design can affect fiscal and operational success—and the nurturing of patients.

It should be noted that owners only get as much out of an RFP as they put in. If they recognize that facilities—and their design—are highly strategic and have a direct effect on patients, staff, and operational success, then the RFP becomes a call to action. It examines how building design (and designers) can support the healthcare mission and future vision. Asked the right way, the questions in an RFP will yield answers that healthcare clients really need. In the end, they get more than an architect or engineer—they get a strategic partner. (Of course, an RFP issuer must also concisely cover basic business and logistic parameters; these are critical and will be covered in Part Two of this article.) The RFP's ultimate function, we contend, is as a strategic tool for optimal medical planning and design. To achieve that ideal, take three steps.

Step One: Take the Broad View


How will your firm promote and foster the integration of new operational models for the hospital?That's how the Carle Foundation in Urbana, Illinois, concisely and clearly captured the big picture in its RFP. Determined to tap into the ideal relationship between A/E firm and care provider, this client rejects the idea of design as commodity. For them, it's a tool of leadership based on innovation and hard work. Good firms, they believe, will know how to respond.

Rather than zooming in on details, the RFP should take in the view from the mountaintops. Remember, the document initiates a multiple-year relationship that bears on an organization's very success. Hospitals are wildly complex and have many stakeholders. Process and plant are equals, and the operating costs may be 10 times the capital budget; in fact, MEP systems alone average 45% or more of facility costs. Perhaps that's why in the past many executives punted on architect selection, sending it to the facilities team or, in some cases, the purchasing office. But times have changed, and now board members and executives are taking greater interest in architect selection and becoming active participants in the RFP process.

The big-picture RFP opens doors to better processes, better delivery, and better care—in other words, healthcare leadership. Asking how A/E firms differentiate themselves may provoke an avalanche of useless marketing lingo; instead, have them address the impact their designs have had on the strategic or care delivery success of the healthcare organization and if their firm provided solutions that have reduced operational expenses, as Sutter Health did. Invite candidate firms to define “healthcare best practices” or cite examples of state-of-the-art hospital operations that they have designed. By showing unique models of facility organization or process engineering, firms can demonstrate that they've done truly cutting-edge work.

Step Two: Get Specific on Key Trends

Describe your understanding of evidence-based design principles, green-building design measures (LEED), and how you evaluated and implemented these measures in previous projects. When a large Midwestern children's hospital needed a facility to match its world-class care, it included the above request for information in its RFP. The responses helped the organization to winnow down a large field to the truly capable.

There's more to this hospital's qualification process, of course, but its approach encapsulates another piece of RFP advice: Get specifics on key trends. Carle Foundation's RFP, for example, included the question, “How has your firm incorporated and developed alternative healing environments into the design of hospitals?”

If evidence-based design is vital to your facility planning, make it a prominent criterion in the statement of qualifications. A recent RFP by a large, southern university hospital, for example, asked for a design team “experienced in evidenced-based design, applying it to the design, fostering transformational collaboration with a wide range of stakeholders, and rigorously testing the design to see if it achieves the desired goals”. Their request not only acknowledges that complex specializations are key, but also that acquiring these capabilities comes from sitting down with hundreds of physicians, nurses, patient advocates, and executives.

Sustainability also matters, and leading care providers look for answers—and case studies—that go beyond energy efficiency and renewable materials. When 70% of the annual budget is salaries, the definition expands to capture emotional, fiscal, and operational sustainability.

The University of Minnesota Children's Hospital, Fairview, lists among its evaluation criteria not only experience in LEED but also in lean—that is, lean design principles. Whatever their goals—whether green, lean, or alternative healing—savvy owners issue RFPs asking for technical design expertise and the firm's involvement “on the ground”—implementing and evaluating these measures.

Step Three: Request Excellence

Explain your firm's approach to interior design, and describe the importance of interior design in creating a healing environment. When a large, urban university hospital wrote this in their RFP, the organization instantly transcended the typical focus of designer selection, such as experience, fees, and referrals. It immediately telegraphed to the recipients, “We want to have the best interiors possible—and the best service provider possible”. Similarly, but more succinctly, the Carle Foundation asked, “What is your firm's design philosophy?”

Learning on the job is a liability. A well-crafted RFP can actually help mitigate owner risk—in facility planning and construction as well as in operations—by targeting inefficient and wasteful practices.


Owners can limit variability, reduce the possibility of unexpected outcomes, and turn mere collaboration into full-on integration. And they can guarantee that the right tools will be employed to measure the design deliverables, whether that means computer analyses, mock-ups, simulations, or postoccupancy evaluations.

The aforementioned southern university hospital's approach to RFPs makes it clear that its decision involves more than calculating construction costs: Design establishes excellence over the long haul by “fostering transformational collaboration”. The qualities this hospital values include:

  • Deep knowledge of the research literature linking design to quality and safety outcomes;

  • The ability to use evidence to help understand the life-cycle implications of design and programmatic choices for both clinical operations and building performance; and

  • Experience with quantitative and qualitative analyses of comparable best practices, including testing of intermediate and final designs to determine whether goals have been achieved.

Does this sound like a typical building project to you? Scarcely. It's more like clinical research or hard science. Yet, for the healthcare organization ready for world-class facilities, building a world-class selection process should come first. HD

Part Two of this article, to appear in a future issue ofHEALTHCARE DESIGN, will discuss client expectations, project organization and scope, key deliverables, specific services, and budgets outlined in RFPs.

Jens Mammen is a Principal and planning practice leader at SmithGroup, one of the nation's leading healthcare design and planning firms.
Anne Belleau-Mills, AIA, is a Vice-President and leader of SmithGroup's national health practice. The firm's healthcare portfolio includes facilities for many of the nation's leading healthcare providers, such as St. Jude Children's Research Hospital, the University of Virginia, Kaiser Permanente, the University of Louisville, and the University of Chicago Hospitals.