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Is designing healthcare for “good enough”… good enough?

With the drive towards a more affordable and accessible healthcare model in the US, should design “excellence” always be the standard?

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Voltaire once said, “Perfect is the enemy of good,” meaning that the effort to achieve excellence can be so exhausting or so expensive that it can often be unattainable. A definition of “excellence” is “exceptionally good,” so isn’t “good” or “good enough” a target we can aim for and achieve?

If there is one word that is used too many times in corporate “design speak,” it’s the word “excellence.” It shows up on mission statements, in corporate values, and in conference papers and presentations. Yet as Voltaire suggested, do we always need to strive for excellence all of the time? If everything reaches excellence, is the term rendered empty?

Acute healthcare, and especially surgical procedures, is an exact science. Tolerances are unforgiving, from basic hygiene to the ever-evolving surgical and diagnostic technologies. However, an increasing proportion of healthcare takes place outside of such high-performance arenas.

With that key difference in mind, it could be argued that the need for the exactness or perfection of a surgical unit does not necessarily apply across the entire healthcare continuum. Healthcare, therefore, as Collin Beers, a principal at Stantec, has argued, can only work as a generic term – building codes and requirements for an inpatient hospital are very different to an outpatient or primary care setting.  

If we take the inpatient bedroom as the most repeatable element for hospital design, we have certainly seen a real improvement since the Hill Burton Act in 1946 which supplied grants for new hospital construction and (by implication) set space standards. Yes, it led to the double room, but that was an improvement on the open, multibed ward. Fast-forward to today and we have patient suites and codes in the US that dictate private rooms that seem to relate more to standards of hospitality than to clinical outcomes and related costs. 

As the spotlight moves to outpatient and primary care, we need to build that new frontier that fulfills its purpose clinically and financially without overthinking or elaborating too far beyond its basic function. This outpatient setting is where we’ll likely see the most growth, so this shift gives us the opportunity to recalibrate what is realistically required. This may mean learning from our history, particularly the pioneering work of Dr. Ruth Cammock in the UK, as described in her book, Primary Care Buildings (published in 1981 by London’s Architectural Press). Dr. Cammock was both an architect and physician who reminded us that the most important space in a patient’s healthcare journey is the point where he or she first begins it – likely just a room in which patients and their doctors or nurses speak one-to-one about a condition and preliminary assessments and prognosis. For many, that journey will end there, maybe with a prescription for medication, or maybe a follow-up visit. The buildings required to house such basic activities are more about “high touch” than “high tech.”

So, within this context, I return to my original question: Do we always need to strive for excellence? A Ferrari or Rolls Royce represents excellence in cars. But for most of us, an affordable, safe, and reliable car like a Volvo or Ford will do – something that is “good enough” to get us to and from our destination. We would be wasting our money and resources on the Ferrari – money that could be better used for other needs.

If we look into the new paradigm in US healthcare with the drive towards a more affordable and accessible model, then surely we should stop putting the focus on pursuing “excellence” when it comes to primary care – we cannot afford it. Instead, let’s focus on the goal of providing patients with access to their doctors for advice or treatment in a safe, functional, and reliable environment with a simple outcome of improvement or a cure. With this shift, money and resources can be better spent on the requirements for “excellence” of specialized and acute care facilities. 

To accomplish this, we need only to get back to the basics. We need primary care and outpatient buildings that are good enough to accommodate these programs – let’s go with the Ford instead of the Rolls Royce.

Martin Valins is a principal and healthcare architect.

It could be argued that the need for the exactness or perfection of a surgical unit does not necessarily apply across the entire healthcare continuum.

As the spotlight moves to outpatient and primary care, we need to build that new frontier that fulfills its purpose clinically and financially without overthinking or elaborating too far beyond its basic function.

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