Now, with its third showcase issue, and about to publish its third “regular” issue for 2003 in November, HealthCare Design has made its point: There is a lot more to hospital design than creating space for high technology, specialty care, nursing stations, and patient beds. But who knew how much more?

Every day, it seems, we are discovering newer facets and deeper depths to the subject than we ever suspected were there. Illustrating this point is the sheer variety of approaches to modernized design disclosed by the 104 project entries in this issue. Also illustrative: the articles appearing in our features section.

We'll leave it to readers to discover how healthcare design innovation evolved (“Twenty-Five Years of Planetree Design,” p. 12), how design intertwines with the issue of safety (“Designing Around Patient Safety,” p. 18), and ways to integrate design with commercial offerings in the healthcare setting (“Creating a Center for Wellness,” p. 32). For my part, I'd like to draw attention to D. Kirk Hamilton's exploration of how design and organizational theory work together (“Relating Facility Design to Organization Design,” p. 26). Reading this article conjured up memories of a revelation I had on this subject about four years ago.

As readers may know, we publish a sister publication to HealthCare Design, called DESIGN, aimed at a long-term care audience. For the 1999 annual, I interviewed a facility operator (and trained architectural engineer) named David Green, president/CEO of the Evergreen Retirement Community in Oshkosh, Wisconsin. Mr. Green commented on the creation of a new wing for his facility based on the neighborhood concept: a building consisting of four clusters of nine-resident “households”—rooms grouped around common recreational/dining/service areas—aimed at providing a more homelike setting for skilled nursing residents than the long, double-loaded corridors characteristic of older institutions.

Green said that simply altering the design of a residential facility in this manner proved to be only part of the story. Very shortly he found that day-to-day power in resident care decision making was slipping down from “topsiders,” such as himself and the director of nursing, to the certified nursing assistants and (where possible) the residents themselves in the households. His new facility had decentralized the action and, with it, the responsibilities involved; upper management, including himself, had been relegated to a supportive role. And some organization-wide managers, such as the director of nursing, were in fact no longer needed.

Another revelation for Green: Some staffers thrived on this model and others did not, perhaps finding the new responsibilities uncomfortable; so, for a short while, his facility's staff turnover increased until more staffers were found who melded into the new regime.

In short, he had shaken up his organization and “turned it on its head,” as an inevitable offshoot of his new design. This is the point that Kirk Hamilton explores more thoroughly in his article in this issue. It seems that in design (as in so many things), one can't only “do one thing”—one changes the walls and the adjacencies and, lo and behold, one has ended up changing the organization and its culture.

Leading us on our continued exploration of design concepts this year (as some of them have from the beginning) are our Architectural Showcase judges, depicted here in the throes of the daylong evaluation process. Without their generosity, insights, and guidance, HealthCare Design would not exist. Thanks to them and colleagues like them, this magazine not only exists, but also continues to grow, with a national conference (HEALTHCARE DESIGN .03) coming up in December in Miami, and another set of four issues rolling out in 2004. We are grateful to them, and we hope that readers (and December's conference attendees) will find that these leaders’ time with us will have been well spent. HD


Architectural Showcase judges

Gary Bell, OWP&P

Sheila F. Cahnman, HLM Design

John Fishbeck, JCAHO

Erika Goss, TRO

Karen Jones, HGA

Alan Mack, Proteus Group

Jens Mammen, SmithGroup

Alicia Murasaki, Northwestern Memorial Hospital

Ethel Nemetz, EN Design

Amy Nemschoff Hellman, Nemschoff