HEALTHCARE DESIGN conference, held this year at the Gaylord Opryland Resort and Convention Center in Nashville, brought together luminaries from the advisory boards of HEALTHCARE DESIGN, Healthcare Building Ideas, and the HERD Journal for the morning general session on Tuesday, November 15, in Delta Ballroom A. This was the first time HEALTHCARE DESIGN conference hosted this type of session and from the number of people in the room, it just might not be the last.

The panel was made up of: Debajyoti Pati, PhD, MASA, FIIA, LEED AP, vice president, director of research, HKS Architects; Rosalyn Cama, FASID, EDAC, board chair, The Center for Health Design; Jain Malkin, CID, AAHID, EDAC, president, Jain Malkin Inc.; Sheila F. Cahnman, AIA, ACHA, LEED AP, group vice president/regional healthcare leader, HOK; Kim E. Shinn, PE, LEED AP BD+C, CxA, senior sustainability consultant, TLC Engineering; and Thomas Gormley, vice president, healthcare and life sciences services, URS Corp. Todd Hutlock, Editor-in-Chief, HEALTHCARE DESIGN moderated the session.

The discussion centered on "New Directions in the Future of Healthcare Design" and some very enlightening points were made. Jain Malkin kicked things off and spoke about the current acceptance of evidence-based design (EBD), its recommendations, and the need for further research in this area by the very people in the industry who implement it. This point was echoed by Thomas Gormley, mentioning that although there are plenty of ideas the problem is that they cannot be proven. Basically there is a need for metrics that can be consulted. 

Sheila Cahnman had some interesting insights into some of the current influences on design that she is seeing. The industry is certainly witnessing more consolidations and acquisitions while at the same time systems seek to make their processes leaner. As more CEOs in these larger systems lose control of their budgets, she stated, the need for benchmarking and justification of the need for a project has increased, and there's been a greater emphasis on master planning at the front end. "You have to change to build but you have to build to change," she says.

The growing international market has much to offer both in terms of opportunities to work on different projects and to learn from those cultures in terms what works and what doesn't. As Pati noted especially in India, China, Middle East, and South America. These are markets that are forced to do more with less. "There is an opportunity for knowledge sharing," says Roz Cama. Kim Shinn's sticking point on this was the amount of energy that America consumes in its hospitals and yet other nations, notably some Scandanavian countries are finding ways to keep cost, energy consumption, and infection control down.

The panel moved on to talk about the economy and some of the changes some architecture firms have made and how clients have responded to having less dollars to work with. "A lot of firms have moved from the mindset that we're not just architecture companies anymore, we can offer a lot more. The relationship with the client has evolved," says Pati. Other companies in the construction industry are also learning to work smarter, be more efficient, and have a staff in place that can multitask, according to Gormley. Cahnman saw the industry streamlining its processes to save money up front, finding quicker solutions, and not getting bogged down in the decision-making as fees get lower and don't show any sign of rising anytime soon.

It was inevitable that Healthcare Reform would be part of the dialogue. The group touched on some of that in terms of the mandate, healthcare insurance Accountable Care Organizations, primary care and doctors in private practice, keeping Healthcare Reform and Obamacare clearly separated, and how ultimately  there will need to be more accoutability for design, thereby increasing the need for evidence-based design.

"Sustainability is good stewardship. It's not taking more than you need. We're not inheriting this world from our parents, we're borrowing it from our children," says Shinn, "If you're not being sustainable then you're not a good businessperson, you're wasting. Hitting numbers is not what healthcare is about."

Gormley offered that some solutions to the changing future is getting good people and advocates and supporting students in this field as they are the leaders of the future. "Our profession and the world suffers from resistance to change," says Shinn. From the construction and engineering side of things, he sees BIM as a leading change in that industry. "Modeling instead of drafting is a sea change," he says. 

"By nature we sustain the things that are beautiful. If a building is beautiful, the people are in it will sustain it," says Pati.

The changing landscape of EBD is an indication of the need for flexibility in the design of the building but also from the people who are involved.