With 1,200 locations, 16,500 beds, and 20 million outpatient visits each year, Ascension Health spends hundreds of millions of dollars annually on capital improvements.

However, despite its size, there had previously been no structure in place to streamline projects or establish design standards across the health system. In fact, the severity of the shortcoming was evident in two projects being built about 15 miles apart from one another in the Detroit area, with two separate architects and two separate contractors.

“We ended up in the same city with two different patient room configurations—basically, two different everything,” says Robert McCoole, vice president, facilities resource group, Ascension Health. McCoole, who has spent his career on the construction side of the industry, was brought on board to lead the facilities resource group and undergo the establishment of design standards that would help alleviate some of the mounting costs Ascension continued to face.

He shared his story during the HEALTHCARE DESIGN.11 conference on Monday at the Gaylord Opryland Resort and Convention Center, during the session “How Does the Architectural Profession Respond to Utilizing Design Standards Within a Large Healthcare System?”

Two drivers toward the change were the non-profit’s shortage of capital to allocate to projects. “That’s a driver toward a lot of things, too. But it’s a driver for standards,” he says.

The second push came in light of ongoing unknowns surrounding healthcare reform. With an unsustainable federal deficit subsisting and healthcare costs for the average family skyrocketing, McCoole simply states: “Something has got to be done.”

What that’s translated to for Ascension was found first in the facilities resource group’s quest to rein in costs and to do so through establishing design standards. The group selected a preferred group of firms to tackle master planning, architecture, engineering, program management, and construction. And if one of the system’s health ministries has a project of more than $10 million, it must use those preferred firms.

The firms were chosen prior to the onset of the change, which came at the height of the downturn and at a time when Ascension had no projects to award anyway. So the group set to work on the design standards.

However, as projects have now begun across the country, Ascension has seen challenges, including the local ministries pushing architects to address their specific wants and needs, and architects, at times, allowing plans to go too far in that direction, as opposed to in the direction of the standards. “There is too much input given to the architects … they are so service oriented, I don’t think they push back enough,” McCoole says.

And while the debate over whether establishing standard in turn kills creative design persists, McCoole says that’s not the point at Ascension. “I’m a huge fan of design; we just can’t afford it,” he says.

So the question really comes down to that fine line of what differentiates design to the extent that it contributes to safety, satisfaction, and patient outcomes, McCoole says. What has value? Room size? Finishes? Daylighting? Family features?

“It’s like there’s an arms race, and everyone wants to do the next cool thing,” he says.

Valid questions do remain, though, he says, such as whether design standards discourage creativity, are logical in a time of fundamental change in healthcare, achieve a shortened delivery time, or whether they fail.

I look forward to seeing how the effort progresses going forward.