Since President Obama’s bill was introduced last year, health reform has been covered from every potential angle possible in the general media and healthcare trade media. While there is much agreement that we are in need of health reform, there is little agreement on what reform looks like, who will pay for it, and how and when it will come to fruition.

Few can argue against the vision of universal access to high-quality and affordable care. Even for those in our country who have had unlimited access to quality care, the cost of that access is increasing dramatically year after year in a way that is unsustainable for both individuals and businesses that provide healthcare coverage to their employees. And for many, access to quality care is not even within their reach. Solutions to these issues are complex and will be debated in a public and national forum for years to come.

The question for the healthcare and design community is what role the built environment can play in helping to provide high-quality, affordable care to broader audiences. The answer is multifaceted—from influencing human behavior to reducing the risk of medical errors, the built environment can and inevitably will need to be a part of the solution.

Those on Capitol Hill need to understand that it is impossible to talk about healthcare without also including the environment in which that care is provided. The upfront capital investment in a facility pales when compared to the long-term operational costs.

Articles such as “Fable Hospital 2.0: The Business Case for Building Better Health Care Facilities,” published recently by The Hastings Center (an excerpt of which appeared in the April 2011 issue of HEALTHCARE DESIGN), have linked reduced operational costs to appropriate upfront investments in capital projects. This article, written by a group of The Center for Health Design volunteers, lays out the direct relationship between one-time capital costs and long-term operational savings. It is a must-read if you are involved in any aspect of healthcare design. So what voice should our community have in this conversation?

To start the discussion, here are just a few of the many ways the built environment can contribute to universal access to high-quality care:

Patient safety
Studies have linked the built environment to everything from reducing the spread of infection to a reduction in medical errors, both of which reduce the overall cost of care in the long term.

Workforce safety
Nurses suffer more back injuries than construction workers. An aging workforce and increasingly obese population have added to an already significant problem. Incorporating a patient lift system into the patient room is just one way to reduce the potential for injury to staff, while increasing a sense of security and maintaining patient dignity.

Access to care
Community health centers conveniently located within the community—close to where people live, work, and play—help provide easy access to care and encourage healthy lifestyle choices. Outreach programs can more successfully reach their target audiences when they are well integrated into neighborhoods. Some excellent examples of community health centers, as well as design recommendations and a solutions library, can be found on the newly launched Clinic Design website at

Integrated care teams
Creating spaces that encourage collaboration and the easy and efficient sharing of information between health disciplines and family members or caregivers has been shown to lead to better long-term outcomes for patients.

Environments that promote health and wellness
Creating built environments that encourage healthy lifestyles may, in the long term, help reduce the need for expensive medical interventions. An example of this is locating inviting stairwells in centralized areas of a facility to encourage patients, staff, and visitors to take the stairs over elevators.

These are just a few of the many ways the built environment can relieve some of the stress on our healthcare system. The question for the healthcare and design community is not only what role the built environment can play in helping to provide high-quality, affordable care to broader audiences, but also what role, as an informed member of this community, will you play to educate those who influence healthcare reform? How can you, too, be part of the solution? HCD

Debra J. Levin is president and CEO of The Center for Health Design in Concord, California. Follow her on Twitter @CHD_DebraLevin.