Innovation requires risk; healthcare is a risk-averse industry. It’s an axiom that’s created a challenging climate for the healthcare design community—from the providers pursuing new projects to the architects who design them to the manufacturers whose products fill them—to push built environments forward.

This institutional culture that relies so heavily on research and proven methods was among the most commonly reported reasons why our industry can be (sometimes maddeningly) cautious, according to the Healthcare Design Innovation Survey. “Innovation cannot always have evidence to back it up. Sometimes you just need to take a chance and try something new,” said respondent Cathy Dolan-Schweitzer, president of consulting firm Health Well Done (New York).

And for many, that time is now. “We try to solve for tomorrow with the thinking of yesterday,” noted Tim Prince, senior adviser at Findorff (Madison, Wis.). Indeed, healthcare in 2015 is a whole lot different than it used to be. Reform and shifts in reimbursement models are pushing the need for care delivery methods to evolve—and to rethink building and design approaches of old.

However, it’s this new business landscape that’s creating even more hesitancy to try something new, thanks to all of the cost implications that come with reform. “[The greatest challenge to innovation is] getting clients to make the investment to look at the alternatives and evaluate the short-term/long-term implications. Reduced reimbursements and financial pressures while accommodating the Affordable Care Act is their key focus,” noted the president and CEO of an architecture firm working in healthcare.

This dynamic has created an environment where the same old, same old may appear to be the best solution for costly building projects when considering the potentially equally expensive cost of failure if innovations fall flat. “It’s too tempting to repeat previous solutions that once worked well but are not in tune with today’s greater concerns for patient comfort, efficiency, and sustainability,” added another healthcare architect.

But perhaps the biggest challenge to innovation is simply knowing what needs to be innovated and why. Where should industry members focus time, effort, and money on creating new solutions? And where does it make more sense to use what we know?

Healthcare Design turned to its audience of industry professionals to weigh in. The Innovation Survey was conducted online November 2014 through January, with 398 respondents sharing their thoughts. Of those, 36.3 percent were from architecture firms, 18.4 percent from healthcare providers, and 15.4 percent from suppliers or vendors, with independent consultants, engineering firms, interior design firms, construction firms, educators, and landscape architecture firms represented, as well.

(Charts capturing all of the data collected via the survey can be found in the image gallery.)
Starting point
All building projects start at the same point: identifying a provider’s goals. And the key to any innovation is figuring out what it’s meant to accomplish. For survey respondents, the single most important objective for design programs was patient outcomes, garnering 31.2 percent of respondents’ votes, followed by patient satisfaction at 25.3 percent and efficiency at 17.7 percent. The most common secondary objectives were patient satisfaction, infection control, efficiency, and staff satisfaction.

So how is the industry doing at supporting operations and healthcare providers’ goals through innovation? For the most part, just OK.

Respondents overwhelmingly selected that “some innovation” was happening across the board, from project planning to product manufacturing. Some sectors were a little more “ahead of the innovation curve,” such as architecture, which got 31.7 percent of respondents’ votes in that category, and interior design with 34.3 percent. The leader in “cutting-edge approaches” was product manufacturing, although it got that nod from just 10 percent of respondents.

No industry sector was overwhelmingly marked a laggard, either, but construction and landscape architecture both made it to double digits for “little to no innovation,” tagged in that category by 20.7 percent and 18.7 percent of respondents, respectively.

 

Looking closer
To determine where exactly these different industry sectors are bringing the most innovative solutions to the table (and where they’re not), the Innovation Survey dug a little deeper, starting with technology integration. Respondents were asked to rate multiple healthcare spaces, such as nurses’ stations or EDs, on a scale of 1 to 5, with 1 being the least amount of attention being paid to innovating technology integration in that area and 5 the most.

Surgery spaces won out as seeing the most technology innovation, with 29.2 percent of votes under “greatest,” followed by diagnostics and testing at 20.6 percent, with EDs, labs, and patient/exam rooms all in the ballpark of 18 percent. Overwhelmingly, though, most respondents categorized technology integration efforts across healthcare spaces in the mid-range of 3 and 4.

For those weighing a little more heavily on the lower end of the scale, 18.2 percent of respondents said retail areas/amenities see the least amount of effort made to innovating technology integration, followed by 12.6 percent for both family/visitor spaces and lobbies/reception.

So what exactly are healthcare providers’ focused on when it comes to technology projects? From “no activity” to “lots of activity,” respondents gauged what they’re seeing.

Leading with 35.7 percent of votes for lots of activity was providing wireless capabilities/Internet connectivity in public spaces, followed by 33 percent in adopting mobile technologies to support staff, and 26.5 percent to demanding flexibility in spaces to accommodate future technology/equipment.

On the low end, 11.7 percent of respondents said they’ve seen no activity in dedicating space to telemedicine, though 66.1 percent reported “a little activity” or “some activity,” followed by building data centers or hiring partners to manage/store data, with 7.4 percent reporting no activity but 59.6 percent saying there’s little or some.

As for space planning and workflow, again using the 1-5 scale, the ED won out in innovation with 26.3 percent of respondents seeing the greatest amount of innovation in planning there, though surgery came close behind with 21.4 percent of responses, followed by a tie between patient/exam rooms and inpatient units at 20.2 percent, with the majority of respondents ranking spaces between 3 and 4.

Once again, retail areas/amenities and lobbies/reception got the most votes for where the least amount of innovation is being seen on the planning side, at 16.1 percent and 11.5 percent, respectively.

Next weighed was innovation in construction approaches/strategies. The survey asked respondents to rate everything from resiliency to sustainability to technology integration on the “a lot of innovation” to “very little to no innovation” scale. Overall, most votes fell in the middle, “some innovation,” but 25.4 percent of respondents reported seeing good progress in both Lean approaches and technology integration, followed by design/on-site technology at 19 percent.

The most votes for “very little to no innovation” were given to resiliency at 24.1 percent, p
refabrication/modular components at 23.7 percent, and MEP/building systems at 19.9 percent.

 

Pack leader
As noted earlier, among healthcare design industry sectors, product manufacturing received the most votes at 10 percent for providing “cutting-edge innovations.” The survey also asked respondents to rate the level of innovation taking place in the vendor realm, starting with materials selection across a variety of hospital spaces, from patient rooms to surgery suites to retail areas.

On a scale of 1-5, the greatest amount of attention being paid to innovating materials selection was reported in surgery spaces, with 22.1 percent of respondents giving it a 5 vote, followed closely by lobbies/reception areas with 21 percent. Patient/exam rooms, family/visitor spaces, and inpatient units all saw about 15 percent.

On the other end of that spectrum, 7.8 percent of respondents said they’re not seeing much advancement in materials selection in retail areas/amenities spaces, with another 7 percent saying the same for nurses’ stations/staff workspaces. Overall, though, most respondents stuck to the middle ground with votes of 3 or 4 across space types.

Comparing innovation across different product categories, 35 percent of respondents said that lighting takes the cake with “a lot of innovation” seen, followed by surfaces with 21.5 percent and fabrics/textiles at 17.6 percent. “Very little to no innovation” was most often reported in casework with 35.6 percent of votes, although 44.2 percent of survey takers reported seeing “some innovation” in casework. Signage/wayfinding was also among the highest vote getters for lack of innovation at 30 percent, with 46.8 percent saying some is happening. Finally, art earned 24.5 percent of votes for no innovation and 45 percent for some.

And for the most part, these numbers seem pretty fitting when respondents were asked what product categories actually should be innovated.

For example, 24 percent of respondents said art needs “very little to no innovation,” with 12 percent saying the same for casework—again, both also on the low end of where it’s being seen. On the other hand, signage/wayfinding was among the top three categories where respondents said “a lot of innovation” is needed at 51.5 percent and another 41.2 percent saying “some innovation” is needed—a  likely indicator that its low score for innovation could be improved upon.

However, lighting, noted as the product category being advanced the most, appears to be answering that call, as 68.7 percent of respondents said innovation should be happening there, followed by furniture at 52.8 percent.

 

Onward and upward
As for the future of innovation, respondents pointed to another axiom: Form follows function. Many stated that true healthcare design innovation first requires the continued reimagining of our healthcare system and how care is delivered.

“Clinical models of care should drive design, and a good design process can help push the envelope. It can be a challenge to move care models to more innovative approaches in a timely way,” said survey taker Shauna McMahon, director of technology and infrastructure renewal at Capital Health District Authority (Halifax, Nova Scotia, Canada). “You need to leverage those who are willing to be innovative and work with them to create new workflow and process changes.”

Key to this process is recognizing that the goal posts are moving, transitioning from those once driven by volume to today’s outcome-driven environment. “There is not adequate correlation between innovation and hospital priorities like patient outcomes. The new reimbursement requirements are shifting priorities,” added Ashley Mulhall, architect and sustainability manager for Orcutt Winslow (Phoenix).

“The greatest challenge to innovation today in healthcare is providing the best care. This includes efficiency and technology, state-of-the-art devices to manage health, response time for results, and connectability with doctors, staff, and patients. Wellness, peace, and sustainability are our goals in life today. Design for innovation should include all of that,” continued respondent Malia Hall, a marketing and strategic leadership volunteer at Sharp Chula Vista Medical Center (Chula Vista, Calif.)

But then again, it all goes back to cost—and that potential for risk. Some believe the answer is collaboration, with healthcare design firms helping providers navigate where to invest in more appropriate solutions.

“True collaboration and partnership between the design/build industry and the leadership teams at provider organizations need to be strong enough so all perspectives, ideas, and insights can be thoughtfully brought forward and evolved,” added Julie Mackenzie, CEO of consulting firm Mindsailing (Minneapolis).

And once a plan is realized, implementation and measurement of how well an innovation worked are critical, as respondents also noted that post-occupancy evaluations should be no less valued when trying something new.

But it all starts with taking a leap. “Innovation only happens when it’s safe to fail,” says Tracy Bolo, learning specialist, healthcare, for Herman Miller (Holland, Mich.).

Jennifer Kovacs Silvis is executive editor of Healthcare Design. She can be reached at jsilvis@vendomegrp.com. 

The innovation conversation will continue throughout 2015 at our regional Healthcare Design Academy events, where the Healthcare Design editors will present more details on the findings and engage attendees in a “what’s next” discussion. For more information, including dates and locations for the 1.5-day programs, visit HCDAcademy.com.