You are holding our fourth annual Architectural Showcase issue in your hand and, as you might have noticed in hefting it, this issue is easily the biggest we've ever published. It includes the widest variety of project types we've displayed, some unusually outstanding citation winners, and probably the greatest chance our readers have had to find ideas of direct usefulness to them from the projects offered. Growth like this is a good thing—but with growth, as anyone who has gone through the experience can tell you, come growing pains.

This was a reflection that came to mind as I monitored the design review session that yielded this hefty issue (meet the reviewers in the accompanying photo). In sorting through all the submitted projects, some reviewers alluded to a disparity they sensed between the energy and resources that went into creating exteriors and public spaces and those devoted to patient rooms and staff support areas. It wasn't that the glossy public areas necessarily fronted for mundane, minimalist patient rooms; it was just that for some projects they didn't see much evidence to the contrary. HEALTHCARE DESIGN plans to promote more patient room inclusions in next year's review, but for now the reviewers' worry remains unresolved.

That critical stance can be taken as a good sign; it's an indication that healthcare design is continuing to evolve and grow, that practitioners are far from settled as to its destination and how to get there. It's what one might call a growing pain.

Another might be the uncertainty reviewers expressed about private rooms. These have by now, of course, become part of the “better design” mantra, and they are fully endorsed by the American Institute of Architects. Yet some reviewers wondered if doubles weren't still the way to go for cash-strapped rural hospitals trying to plan for unpredictable growth, or for certain rehab and extended-care facilities where patients might welcome the company. In short, an option that appears to be clearly desirable turns out to depend on many factors—still another sign of a discipline in progress.

Yet another important sign of the field's growth, both in scope and in scale, can be found in our feature article on a United Kingdom project called the Maggie's Centres (p. 20). Following the death from cancer of a woman who had eloquently noted in her last days the influence the environment was having on her sense of well-being, and spearheaded by her husband, world-renowned landscape architect/critic Charles Jencks, Maggie's Centres were envisioned in the mid-1990s as a set of uniquely designed outpatient gathering places for cancer patients. Some of the world's leading architects and designers were asked to create these places based on their own concepts of healthy environments. The Centres are much smaller than the projects these designers are accustomed to working on; they are certainly nowhere near what one reviewer calls “the modern cathedrals” that you'll find among some of our more ambitious Showcase entries. But healthcare design as conceived today can accommodate both types of project—but with plenty of room remaining for interpretation, self-questioning, and redefinition.

So, enjoy the ride—the excitement and unpredictability of a field still undergoing its growth pains. Maybe you'll be inspired with ideas that will help take us to the next level of healthcare design. HD