“Make no little plan. They have no magic to stir men's blood.”

-Daniel Burnham, father of the Chicago master plan, in 1909

Travel freezes, capital projects being put on hold or cancelled altogether, layoffs, declining sales: These are the topics of daily discussion that have greeted us so far in 2009 on every television news station, in every paper, and on the lips of our colleagues when we ask them how things are going. I started my career in the 1980s when the healthcare and design industries were facing similar concerns, but everyone is quick to point out that this is worse, more global, more ingrained. The conventional wisdom is cautiously optimistic that things will start to turn around slowly in September. I'mnot sure how anyone has been able to pinpoint a specific month, but those in the financial industry are far more versed than me when it comes to understanding the trends that predict these things; I am hopeful that they are right.

Without a doubt, these are complicated and difficult times, but they also provide us a rare opportunity. This past decade has been an extraordinary one of growth and abundance for the healthcare design industry. We have seen rapid expansion, easy access to capital, extraordinary creativity in building designs, and the use of research to begin to inform design decisions. In many ways we were treading water to stay afloat with all the activity. The Center for Health Design was getting two to three calls a month from firms looking for experienced healthcare architects or interior designers. The demand for skilled practitioners far outweighed the supply of available professionals.

With this sudden slowdown comes an opportunity to hit the pause button and think on a comprehensive level about the work we are doing and the projects we are creating. Just like Daniel Burnham had an opportunity to create a master plan for the great city of Chicago, which to this day still benefits from his vision, we can take this time to plan carefully what the next generation of healthcare facilities will look like and to question old assumptions of where and how healthcare will even be administered. Though these are questions we have been asking ourselves all along, we have not had the luxury of time to truly contemplate the wealth of opportunities and understand the ramifications of how the results of what we are building today will last us far into the future and can support the highest quality of life for our communities.

We also have an opportunity to build a comprehensive database of research that allows us to make design decisions based on research where possible and to begin to identify the many areas where either no research or not enough research exists to support sound judgment. We have been engaging in this work at The Center for Health Design and will continue to partner with others and help to facilitate the discussion. However, it will take a coalition of many associations, universities, design firms, and healthcare organizations to do the work that we have in front of us, especially if we are to be able to make progress in a timely enough manner to leverage the knowledge during this current building phase. For those of you who have not done so already, I encourage you to visit the RIPPLE database (http://www.ripple.healthdesign.org). Register and participate in a forum on the newly launched ACT portion of the site or start your own discussion group. If you have articles that you find useful, post them. We hope that this database will grow organically as the field grows and will work over the next year to target design guidelines from as many healthcare facilities as we are able to gather to add to the database's usefulness.

Though these are difficult times, they are also defining moments-moments that will shape the next generation of healthcare facilities, and if done well, our communities. HD

The Center for Health Design is located in Concord, California. For more information, visit http://www.healthdesign.org.
Healthcare Design 2009 June;9(6):10