I recently read in one of the many monthly magazines I subscribe to (with all good intention of reading them when they arrive) about the scientific theory of the “expectation factor.” I was intrigued because I have long believed that to achieve we need to “keep our head in the clouds and our feet on the ground.” To me this saying was just another one of those quotes I collect along life's way that seem to stick with me, but it piqued my interest to learn there was now a scientific theory backing up all those homilies I keep in my back pocket to keep me going.

Many studies have shown that teachers who expect increased performance from their students get it—in fact, as much as a 30% improvement. This is also true for coaches and athletes and, yes, even laboratory rats. Lab rats given to scientists who had been told that their subjects were from a wizard strain did 65% better in their maze navigation than their supposedly not-so-smart peers when, in fact, all of the rats came from the same strain.

This led me to think about the leadership role of those planning and designing healthcare facilities. So often projects start out with such high hopes. The team has great vision, but frequently things start to change. Budgetary realities cut visionary ideas; crunched timelines inch out unique features. And before you know it, the vision and the reality are distances apart.

Can we possibly achieve better results just by setting the bar higher? Is it, in fact, the job of the design team to set the bar high to achieve great results? Expectations are not the same as high hopes. High hopes can be beaten down by those with less imagination or by groupthink. Expectations, on the other hand, are a set of minimally acceptable results. Far too frequently, because of past experiences, expectations are set low in an attempt to avoid disappointment.

I have heard over and over again from design professionals that to build a great building, you need a great client. I'm sure that if I surveyed healthcare executives they would say the same of design professionals. But that's looking at the person across the table and putting the success of the project on his or her shoulders. The expectation factor would lead us to believe that the burden needs to fall on our own shoulders and that if we keep the bar high, those we work with will raise their bar, as well.

In June, The Center for Health Design, in a project funded by the Robert Wood Johnson Foundation, held a national press briefing and a small think-tank conference to unveil the preliminary results of a comprehensive study entitled “The Role of the Physical Environment in the Hospital of the 21st Century: A Once-in-a-Lifetime Opportunity.” It brings together the findings of more than 600 studies, most from peer-reviewed journals and all supporting the theory that, like evidence-based medicine, evidence-based design can contribute to health, economic, and satisfaction outcomes in hospitals and healthcare facilities.

The United States is embarking on one of the largest healthcare building booms in our history. These buildings will affect our healthcare system for decades to come. The bar has now been raised for our industry. There is no turning back. These are our new expectations. How can we not expect that what we now know is now not only possible, but proven? HD

The Center for Health Design is located in Concord, California.