Is I write this we are approaching the opening day for HEALTHCARE DESIGN.05, our third annual conference, which runs from November 6-9 in Scottsdale, Arizona. It will come as a surprise to no one that recently we carefully reviewed our registrant listings to see which of the 30 educational sessions we scheduled for those days have attracted the most interest. One of the most popular sessions: “Selling the Numbers to the Board of Directors.”

That session's description admits that it isn't easy to make a compelling case for a project to a cost-conscious board but states confidently that it can be done. The speakers for this session propose addressing such topics as life-cycle costing versus “first-cost mentality,” selecting the right metrics and cost parameters, reducing terminology that weakens the business case, and demonstrating that good design saves money. All of this is an obeisance to the almighty deity known as The Project Budget.

If one needs further demonstration as to why this is such a popular topic, one need only to hearken back to an article we published this July (p. 44): “The Good and the Bad of Value Engineering,” by Anthony J. Haas of Watkins Hamilton Ross (WHR) Architects of Houston and Steve Howard of Cumming, LLC. Haas and Howard pull no punches in criticizing project planners who, rather than viewing value engineering as a way of achieving more cost-effective design to achieve project goals, approach it as simply a cost-cutting exercise that devalues the project with a blunt meat ax. The authors offer several all-encompassing definitions of value engineering, and they encourage a team approach focused on retaining and ensuring project value in relation to hard dollars and cents. Value engineering, in proper form, binds together the concepts of value and budget, as opposed to chopping away project elements simply to save money, with no further thought given to project goals and purposes.

These contrasting views resonate with this longtime healthcare journalist, who has seen managed care (particularly HMOs) and long-term care providers routinely pilloried for putting cost ahead of quality. Many will recall HMOs being cast as the “heavies” in movies involving lifesaving healthcare. Nursing homes, meanwhile, have become a standard target for the muckraking press. The indictments are not always fair; some managed care companies have worked to enhance cost-effective care, and nursing homes must grapple with a heavy reliance on severely underfunded government programs, principally Medicaid. But the negative images predominate.

Still, on the flip side, let's admit it: Within the business milieu in which they operate, “tough, hard-nosed” executives often do better with peer esteem and career advancement than do their more visionary but supposedly less practical counterparts.

Healthcare design projects can cost notably large sums (as evidenced by several hundred-million-dollar-plus projects on display in our September Architectural Showcase issue, for example). Many healthcare organization owners and planners really do seem to back up their visions and goals with real dollars. But it's clear that “tough,” “practical,” “hard-nosed” decision makers are still among us.

May the equally tough-minded visionaries of healthcare design ever rule. HEALTHCARE DESIGN will do all in its power to make it so. HD