In July 2010, my column “Best Practice, Next Practice” identified the drivers for innovation. In it, I noted that the best practices of today are steeped in baseline evidence, and the next practice resulting from innovation springs from that qualified baseline of knowledge, but has to be measured to earn its status as the next best practice. Research currently being conducted will measure some baseline design features and some innovative design features. I have not seen the ratio of those studies reported, but it would be telling to see how much innovation is being validated, therefore raising the bar improving our baseline knowledge.

Early in my career, the concept of design innovation in healthcare was perceived as risky and rarely encouraged. As what seemed like the intuitive next step in design progression was just that, a great hunch. It was the “Trust Me” era. Those in a position to accept our best hunches would ask for some evidence, but all we really had was a small cadre of colleagues in our specialty who once a year or so would gather to share their best practices. So, innovation in healthcare design was slow.

Sometimes those anecdotal tales would be enough to move an idea forward, especially if a Johns Hopkins or Yale-New Haven Hospital were the characters in them. Most often, though, great ideas for innovative concepts to improve healthcare delivery stopped on the desk of the mid-level administrator seeking approval. The approval process was steeped in fear-fear of failure without a baseline of knowledge to mitigate the risk. During the period when we were data poor, even baseline knowledge wasn't strong enough because it wasn't reported evenly. So, typically a healthcare organization's tolerance for design features became its own baseline, no doubt often well below the norm.

Thankfully, that fear level subsided as we embraced the methodology behind the evidence-based design (EBD) process. Checklists have been created and have given a sense of security to the administrator who is not completely up to speed on EBD. The “Show Me” era has emerged. The Center for Health Design (CHD) has become an invaluable resource for all who are designing and building new. CHD's business cases have made strong arguments for how an evidence-based approach to design not only impacts an outcome but also has tremendous impact on an organization's performance and bottom line. So therein lies the catalyst for a surge in healthcare design innovation. Right? Wrong!

You see, it takes a “perfect storm” (to quote a great colleague and fellow sailor, Derek Parker) to enact change. When Derek first imagined the Fable Hospital, we were just starting to share data. We are so much more informed now, and not just the design community, but product manufacturers who partner with design teams and institutions to advance the field. CHD's Pebble Project, Evidence-based Design Accreditation and Certification program, and now the Built Environment Network (BEN) are support groups that offer camaraderie and knowledge-sharing to help propel the next best practice.

Although EBD has created an important foundation for innovation, it is just one step. And we currently have hit a speed bump. A series of external influences have brought design and construction to a halt. Healthcare delivery is changing, becoming more accountable, and that change has the design portion of the industry frozen in its tracks. The economic infrastructure that supports capital improvements has pulled on the brakes; the demographic that is the largest consumer of care is shifting and its demands require more expensive customization of services and advanced technology. Resulting practices are beginning to emerge and be tested; the model of care that transforms itself to one of “accountable wellness” is being incubated, and our government is getting involved to make access to care more equitable. So the liberating EBD conditions for healthcare design innovation of just a few years ago just got a whole lot more complicated.

That said, I believe these shifts will be worked out and at the moment of convergence, or the perfect storm, you all better be poised to ignite the sea change toward innovation. The building boom of the last 10 years allowed evidence-based design to take hold and influence billions of dollars of construction. This screeching halt in new building will now slow the design/build/measure/learn process; but if we are all smart, it will give us time to reflect and redirect.

Many times I've been sailing on Long Island Sound on a typical Connecticut summer day, when the weather and wind is perfect, and then all of a sudden, a wind shift occurs and all that was clear suddenly becomes uncertain. We are in uncertain times right now. Our driving force has shifted, which tells us that our sails have to be reset. The lessons learned on a rough sea can help us to re-engineer our vessel and hone our skills.

I believe these shifts will be worked out and at the moment of convergence, or the perfect storm, you all better be poised to ignite the sea change toward innovation.

That analogy aside, I feel a shift in healthcare design and need to ask, are we poised for the next practice in the development of healthcare interiors? Those of us in healthcare design have a firm baseline of knowledge from which to launch and will come into our next practice as leaders in innovation and human-centric concepts for all other sectors to follow. This shift will reorder the hierarchy of knowledge keepers, and they will create the hospital of the future.

Are you ready to take on the challenge and raise the bar of baseline knowledge through measured design innovation? HCD

Rosalyn Cama is president of CAMA, Inc. in New Haven, Connecticut, and chair of The Center for Health Design's board of directors. For further information, please visit Healthcare Design 2011 May;11(5):8-10