Winning designs reflect two industry trends

The 31st annual Modern Healthcare Design Awards winners this year reflected a pair of trends in U.S. healthcare: its growing international focus and the shift from fee-for-service to value-based reimbursement embodied in the push toward ambulatory care.

Of the five awards this year, two went to projects built outside the U.S. that were dreamt and drawn up by a U.S.-based architecture and design firm—gold medal-winning Humber River Hospital in Toronto and bronze medal-winning Cleveland Clinic Abu Dhabi medical center in the United Arab Emirates, both from architecture firm HDR of Omaha, Neb.

Two more awards this year went to U.S.-based projects that are, substantially, new ambulatory-care facilities: the Swedish Edmonds (Wash.) Ambulatory Care Center, designed by NBBJ, Seattle, won the second award we've given for senior citizen-friendly design, and Kaiser Permanente's Antelope Valley Medical Office in Lancaster, Calif., by architects Taylor Design of Irvine, Calif., won the first-ever award for an environmentally friendly facility.

It was boom times for U.S.-based architects to work abroad building huge projects such as the 4.4 million-square-foot Abu Dhabi medical center or the 656-bed Humber River Hospital. But those times already may have passed, according to Henry Chao, a principal with HOK, a New York-based design, architecture, engineering and planning firm. Chao served as one of seven design awards judges who sifted through more than 70 nomination packages this year.

Work that wins awards today is typically launched years earlier, Chao said, since hospital construction often takes three to four years from groundbreaking to completion.

The hunt for projects abroad “was driven by the recession,” said Jerry Jeter, vice president and principal at HDR and lead architect for Humber River. For HDR, looking over the horizon for clients has been “a big part of our strategy,” Jeter said.

The firm has offices in Toronto and Vancouver, Australia, China and the Middle East. “Five years ago, 5% of our work was outside the United States, Today, 35% is.”

Some years back, Chao said, “There was just a slew of projects in Canada, then Canada cooled down. Then there was a slew of projects in the Middle East.” Today, “the whale-sized projects,” such as the Cleveland Clinic, “are fewer and farther between.”

“The push is more toward population health and keeping people healthy,” Chao said “So there are more (projects) moving to ambulatory.”

The healthcare industry, still has a long way to go before its architecture catches up with patients' expectations, said John Kouletsis, vice president of facilities planning and design at Kaiser Permanente.

“Probably, for the last 10 to 15 years, we've talked incessantly about designing buildings that are patient-focused,” Kouletsis said. “And that's a lot of poppycock. We've been caregiver centric.”

“Of course, the building has to be high-tech and have efficient workflow,” Kouletsis said.

But if cold efficiency is achieved at the expense of customer comfort and satisfaction, patients won't feel as if they're working with someone on their team, he said.

“The trends have been saying, if we're really about the total health of the community, you have to intervene in a much more close and personal way and that's probably not at a building,” Kouletsis said. “If we had the ability to deliver care in just the right time and way and in the venues our patients want,” more and more, that will be in no medical office building at all, he said.