In this series, Healthcare Design asks leading healthcare design professionals, firms, and owners to tell us what’s got their attention and share some ideas on the subject.

Robin Guenther is a principal with Perkins+Will at its New York office and co-author of Sustainable Healthcare, Architecture, Second Edition, with Gail Vittori. To kick off the new year, Guenther counts down her top five ideas that will influence healthcare in 2014, ranked in order of growing importance.

5. Resilience

Whether you recall the hospital closures associated with Superstorm Sandy or the more recent devastation in Moore, Okla., there’s no mistaking that improving the resilience of healthcare infrastructure is top of mind. The President’s Climate Action Plan, released in June 2013, contains just two imperatives for healthcare: reduce carbon emissions and enhance resilience. In “Designing to Avoid Disaster,” architect Thomas Fisher notes that hospitals have become “fracture critical,” with systems so complex that they are vulnerable to the failure of a single element. Our building designs have not accounted for increasing extreme weather. Our answer to grid failure is the ubiquitous diesel generator. But 50 percent of diesel generators experienced problems during the eastern U.S. blackout and they were inadequate for the New York hospitals in Superstorm Sandy. Resilience means incorporating essential redundancy into the everyday infrastructure of hospitals, such as operable windows, daylighting, on-site renewable energy, and cogeneration systems. Hopefully, we’ll stop relegating emergency systems to minimal, normally extraneous capital investments. 

4. Community engagement

Architect Stephen Verderber (“Innovative Hospital Architecture”) sums up this trend with a single sentence: “A hospital is not an island.” Across the U.S., hospitals and healthcare systems are increasingly joining the growing anchor institution movement and investing in their local community’s social, economic, and ecological future. For example, Henry Ford Health System partnered with Wayne State University to launch a “buy midtown” program, offering financial incentives to employees to purchase or rent housing in the neighborhoods surrounding its midtown Detroit campus. The Cleveland Clinic and University Hospitals launched the Evergreen Cooperatives, employee-owned community businesses ranging from urban greenhouses and laundry services to a startup solar/LED lighting manufacturer. Finally, Gundersen Health System’s goal of energy independence in 2014 is being realized through imaginative (but completely replicable) partnerships with surrounding community businesses: harvesting county landfill gas, wind turbines in partnership with Organic Valley, and Cropp Cooperative. The continuing consolidation of health systems, coupled with the enormous purchasing power of healthcare, will continue to propel local community engagement.

3. Transparency on two fronts

The emergence of big data made possible by increased digitizing of medical information (the EMR) is transforming healthcare delivery. The ability to harvest real information about outcomes and relative performance of hospitals—and make that data available to consumers—will continue to drive healthcare delivery improvement. Geographic information system (GIS) data is allowing health professionals to profile the health status and needs of entire communities and map health districts.

Secondly, there’s a revolution in building product composition disclosure, driven by emerging science on the impact of chemical exposures on health and leading healthcare organizations’ response to that science. When Perkins+Will launched its Precautionary List in 2008, we were virtually alone. Today, there’s the Living Building Challenge Declare label, the Health Product Declaration, and third party, multi-attribute certification programs like GreenScreen and Cradle to Cradle. Recently, Healthy Building Network released a comprehensive report on asthmagens in building materials. Organizations, such as pediatric facilities, should take note—we can’t be building clinics with products that trigger asthma.

2. Healthy buildings

Public health physician pioneers such as Howard Frumkin and Richard Jackson are bringing forward the role of the built environment on chronic disease from an occupant to community scale. As they make these links, the entire building industry is learning that creating conditions for health is indeed a design problem and that built environments matter. Walkable neighborhoods provide exercise opportunities for children and adults. Can we encourage the use of stairs instead of elevators through planning solutions? The sustainable design world is recalibrating around health, recognizing that the objective of sustainable design is to preserve the conditions that support health, and we cannot have healthy people on a sick planet.

1. Health care, not disease care

I saved the best for last: health management and prevention. This trend toward reshaping healthcare to focus on the upstream causes of health and disease promises to revolutionize care delivery and the built environments that support it. In our winning submission for the Kaiser Small Hospital Big Idea competition we imagined the transformation of the healthcare portal from the current emergency room (where most current hospital business originates) to a Smartphone, where health system front doors are retail health management portals that assist consumers with primary prevention, health education, and health management activities.

Perkins+Will's rendering of a Wellness Pavilion was part of its submission for the Kaiser Small Hospital Big Idea competition. (Credit: Mazzetti/Perkins+Will)

These are nested not within big box and pharmacy settings (which can encourage dependent behaviors) but in fitness clubs and in partnership with health retailers. Healthcare providers will deliver care first through smart health management apps, where consumers can manage their health status the way they do their bank accounts, and where the hospital is seen as, to quote the UK National Health Service, “a failing of the health and social care system.” We are just a device away from a new competitive healthcare stage—may the system with the best apps win!

Robin Guenther


Want to share your Top Five? Contact senior editor Anne DiNardo at adina
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