With hundreds of projects coming through the door over the years, all hoping to be featured in this issue, there’s an obvious opportunity to observe and record the changing tide in design. Dan Miesle, MHA, EDAC, and administrative director for space planning and facility management at Stanford Hospitals and Clinics (Palo Alto, Calif.), is uniquely qualified to offer perspective on those shifts. He’s been a part of the Healthcare Design Architectural and Interior Design Showcase jury for five years and has more than 40 years’ experience in facility planning, programming, development and construction, ambulatory care, hospital operations, and strategic planning.

The Center for Health Design, on behalf of Healthcare Design, sat down with Miesle to discuss his jury tenure and what he’s learned about the industry through participation.

Linda Franklin: The industry has changed a lot over the past six years. Have the Showcase submissions reflected those changes?
Dan Miesle: Absolutely. The projects submitted always reflect the challenges and what the industry is experiencing at the time. We’ve moved from building a lot of large projects to an increase in smaller projects and renovations. Before 2009, hospitals were putting large new facilities together—those take a long period of time to plan and build. But, after the whole financial situation went south, a lot of projects were put on hold. It’s all a question of capital and access to capital when it comes to these kinds of projects. So I think the dramatic change seen in evidence this year is that there weren’t as many large projects submitted.

Do you see that trend continuing?
Yes. But there will always be a need for replacement facilities, and what gets built will also depend on the niche market for that community. Children’s hospitals, for instance, have very strong fundraising, and so there have been and may continue to be a lot of new children’s hospitals. But I think what’s going to happen in the future is what I saw represented in this year’s submissions, and that was major additions to existing facilities and updates to existing facilities. There’s a constant need to do both renovations and additions to existing facilities, especially with changes in technology and complexity of patient care in the acute setting.

Space is being designed smarter rather than larger. Several of the entries this year addressed the operational and efficiency aspects of certain design elements and then examined how these elements work in conjunction with the design as a whole.

How else did the financial downturn affect the entries?
One result of the fiscal tightening-of-the-belt was better upfront planning. But I think the one challenge that still doesn’t show up in the projects that we review is technology and planning for technology. I really didn’t see any planning or any sort of integrated IT, even to the base level that’s needed, in the design submissions this year.

Payment systems are going to be based on having electronic records, claims, and tracking the condition of patients. Hospitals aren’t going to get paid for infections and readmissions that are deemed avoidable. So, many healthcare dollars are starting to be put into technology, but I don’t think that’s yet reflected in the design submissions.

What else do you wish you’d see more of in the submissions?
I’d like to see more of the client’s voice, to bring the client forward to substantiate that the project achieved or exceeded expectations and goals. The submissions shouldn’t be about the architect or design firm; it’s about the client. And I found, in several entries this year, an alignment of the project with the needs of the client.

Those projects not only aligned with client needs and stated objectives, but went a step further and integrated the local culture and a deeper understanding of the community as a whole. This is something we, as a healthcare community, are becoming more attuned to in both rural and urban areas.

Are there any particularly difficult criteria on which to judge submissions?
One question that all facility planners, architects, and designers must answer is, “What’s the cost per square foot?” But that’s almost a meaningless number on which to base decisions, because in California, for example, the cost is double or triple what it is in the Midwest.

Has your judging style or criteria changed over the years?
My method of judging projects has changed as my own experience has expanded. It’s evolved to evaluate four factors:

• The desired outcomes and objectives of the project. What was the project trying to achieve? What were the challenges?
• Context: how goals were achieved through verbiage and visuals. These buildings aren’t sitting as islands. How can I determine if it was a complex site if you don’t give me a site plan or adequate photos? Unfortunately, too many of the presentations I’ve reviewed didn’t show me enough. They may have talked about how they worked with the nursing staff and came up with designs responsive to their needs, but then they never provided the floor plan. So it’s not that it was a bad project—maybe it was wildly successful and they did everything needed. But as a juror, I can only go on the materials that are provided.
• What research was used and how did that frame the project? I’ve reviewed many projects where they stated they didn’t use any research and that they’ll measure success through a post-occupancy survey. To not review or read published research tells me the submitters really didn’t look at things that might help them create a design that will improve outcomes.
• How were the challenges addressed with the dollars available? I’ve seen several phenomenal projects, but they had endless funds. And I also saw projects that had a tight budget that achieved a heck of a lot for very limited dollars.

Linda Plunkett Franklin is senior marketing communications manager for The Center for Health Design. She can be reached at lfranklin@healthdesign.org.