An engaged group of healthcare leaders, architects, and industry professionals gathered last week in Chicago for the annual Summer Leadership Summit presented by the American College of Healthcare Architects and The American Institute of Architects Academy of Architecture for Health.

Under the theme “Change,” the featured speakers touched on a range of issues from the forces shaping the future of healthcare to patient-centric care during the two-day event.

Many of the healthcare executives offered a “peek behind the curtain” look at the challenges their organizations are facing, their plans for addressing these issues, and the unknowns they see ahead.

While the Affordable Care Act still has many in a wait-and-see mode, the overriding message was a recognition that healthcare organizations need to start acting now on the known—and unknown—changes on the horizon.

And before they exited the stage, many of the speakers took the opportunity to present a few challenges of their own to the audience.

1. Help us make our capital money go further

Richard Braken, chairman/CEO, HCA Healthcare (Nashville, Tenn.), provided his health system’s perspective on trends facing the industry, including an increasing demand for healthcare, the role of government on the impact of care, available physical resources, and clinical effects.

“As an industry, we plan on seeing more people using more healthcare with chronic conditions,” he said.

At the same time, he says the industry is facing a supply gap of 130,000 people, including 65,000 primary care physicians, as well as a more educated and engaged patient base.

“Consumers will expect a relationship-centric approach for their healthcare,” he said.

In response, HCA’s future care model is being guided by the idea of “know me, respect me, show me, lead/connect me,” along with new design considerations that involve optimizing capital and focusing on patient-centric design and operating costs, such as design standards, sourcing/bulk buying, and more offsite/pre-fab construction.

In regards to service, he says many well-known issues—reducing falls, minimizing noise, and making staff work environments more efficient—are still a problem. “Help us with the standards stuff,” he said.

2. Make healthcare settings that produce value

Dr. Paul Barach, principal, J Bara Innovation (Miami) asked attendees to look beyond the healing environment to “accelerate the coproduction of health and healthcare with patients, families, community, and architects and designers.”

Barach said among his dreams for the future are: all healthcare environments are healing environments; they should feel more like home; they should help make getting better easier, not harder; and they should help restore joy in work.

Problems arise, he said, when an emphasis on financial goals at all costs leads to normalized deviance. “Once a community normalizes a deviant organizational practice, it’s no longer viewed as an aberrant act that elicits an exceptional response; instead, it becomes a routine activity that is commonly anticipated and frequently used,” he said.

Examples in a hospital setting are low compliance in hand washing standards or environments with poor acoustics and noise reverberation.

Despite testing and data that offers design-based solutions, Barach said it’s still tough to get clients to pay attention to more evidence-based needs. He also recognized the frustration among architects when value-engineering cuts out innovation

“Your voice has to be heard,” he said.

3. Give us different facilities to deliver meaningful relationships

With the growing focus on better primary and preventative care and community-based delivery systems, Patrick Charmel, president/CEO of Griffin Hospital (Derby, Conn.), and CEO of Planetree, said the industry will need to build new services.

“When we talk about patient-centric, we’re talking about meaningful relationships,” he said. “I believe it takes different facilities to do that.”

Although it’s still not clear what those services and environments will look like, he cited examples from overseas as sources of inspiration. For example, in the Netherlands, the first five minutes of a visit with a physician is simply talking about the patient. “The whole relationship is different, so the exam room is designed differently,” he said.

In this changing environment, he suggested “8 Patient Experience of Care Dimensions,” that must be considered, including: doctor communication, nurse communication, hospital staff responsiveness, pain management, medicine communication, hospital cleanliness and quietness, discharge information, and overall hospital rating.

Steven LIttleson, president of Jersey Shore University Medical Center (Neptune, N.J.), used the analogy of the Jet Star roller coaster that was destroyed during Superstorm Sandy in 2013 to say “the storm is upon us” in healthcare.

Specifically, rising costs, a fragmented healthcare system, disappearing margins, an aging population and a rise in chronic conditions, such as obesity, are among the forces driving change.

With the desire for better clinical integration, he said ACOs can help the industry move forward by rewarding care coordination and developing the competencies and resources necessary to build a viable business model that manages cost and improves quality and patient care.

Among his organizations efforts to adapt are a CMS Palliative Care and the Merdian-Physician ACO Partnership pilot programs and an investment in IT to link all elements of care.

In closing, Littleson showed a picture of the Jet Star stranded in the Atlantic Ocean. The message: a healthcare organization can’t end up like this years from now because it didn’t change.