I’ve been thinking a lot about the concept of “appropriateness” lately. It started when I toured the latest Pebble Project, WellStar Paulding Hospital in Hiram, Ga., that opened a few months ago. I left there with a lot of thoughts tumbling around in my head, but it took me some time to sort through them and figure out why the project had stuck with me the way it did. I felt like I had just seen the hospital of the future, and it wasn’t about futuristic technology, grand design, or statement artwork. Don’t get me wrong—I’m a huge fan of technology, design, and artwork in every aspect of life, most especially in a healthcare facility, and this project incorporated all three of those things. But what stood out was how WellStar made a very different—and I think timely—statement about appropriate choices and appropriate design.

The project had a lot of what it takes to be successful in the first place: an inspired leader as the client and an inquisitive design team. They joined the Pebble Project early on, came to all the meetings and Healthcare Design conferences, took notes, and absorbed what others had done, personalizing the lessons to make them work for them. They incorporated the latest research and best practices as well as thoughtful design features, and they did it in a way that seemed appropriate in our cash-strapped healthcare system.

This thought of appropriate design would have likely left me, crowded out by the regular work-a-day life we all lead, but two months later I went to the judging for Healthcare Design’s annual Design Showcase, where I had the opportunity to review more than 100 new healthcare facilities from around the world. There were some beautiful projects, and it was clear that the baseline of what we’re designing and building has been raised dramatically over the years. I also got to take part in some really interesting conversations.

The jury noted that we are a community that has the ability to consistently turn out beautiful and well-designed projects, but we’ve become stagnant in the area of innovation. We’ve come so far in healthcare design over the last few decades, but over the last few years, not much has changed—or perhaps, if something has changed, it hasn’t yet made its way to the forefront.

Afterward, I wrestled with these two potentially conflicting ideas: designing an appropriate hospital for today’s healthcare needs and economic realities, and continuing to push the boundaries of innovation and the potential costs and risks associated with that.

The synapse between these two potentially conflicting ideas finally came into focus when I was at a dinner for a healthcare innovation think tank, where I had a conversation with a gentleman who had just visited a new hospital. He described how the facility proudly described all the imported materials from distant countries that were used on the project—a hospital in a major U.S. city, not a wealthy Middle Eastern oil nation.

This felt like a perfect time to test the idea I’d been wrestling with for the last few months. What followed was a long and interesting conversation that helped me realize that many others are struggling with these same questions and concerns: How do I rationalize the grand designs I’ve been so proud of over the last decades with the reality that we must design today for an underfunded healthcare system to ensure it a sustainable future?

Design now more than ever has to work on many levels. It has to have a beauty and relevance that inspires and instills confidence in a healthcare institution, all while reducing costs, improving the quality of care, ensuring safety, and reducing the potential for negative outcomes. It has to be appropriate. It has to be innovative. And it has to be unique to that client, that community.

This is a tall order, but it’s a challenge no different from any we’ve faced before. The constraints have been tightened and the bar raised, but design has always been about finding solutions to everyday problems with a beauty and elegance that, after the fact, seem obvious and simple. For inspiration, we can look to communities and industries that have struggled with these same issues, or to countries outside the U.S. that provide high-quality care at a fraction of our own cost. We should search out allied industries that have leveraged the physical environment to reinvent how they deliver services, such as collaborative spaces now found in many educational environments and the wave of food trucks entering the restaurant scene to bring innovative food to a variety of locations.  

The healthcare and design communities have to continue to team together to bring their collective and very diverse wisdoms to the table if we’re going to get there. 

Debra Levin is president and CEO of The Center for Health Design. She can be reached at dlevin@healthdesign.org.