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The need for speed: Lessons learned in the fast lane of design

How one Pennsylvania hospital went from to sod to service in just two years

By Matt Eastman, Senior Associate (Philadelphia, PA)

Two years ago West Shore Hospital opened its doors to provide care for the greater Harrisburg, PA region. The 108-bed facility was designed and built in just 24 months with a fast-track, design-build approach in partnership with Quandel Construction for owner PinnacleHealth. Being a part of this project taught us, as designers, many lessons about what really matters in the design of the healthcare environment. And many run counter to some ideas that we’ve taken for granted.

Good design does not have to come at a premium
In an age of increased accountability for patient outcomes, every dollar spent on facility construction is one less dollar spent on the staff and technology. Moreover, for our clients, every dollar saved on a project today translates to one more dollar towards a currently unfunded project. Although they play a role in creating a comforting environment, public spaces don’t affect patient outcomes; many will pass through them on the way to more significant destinations. Those spaces are transient and are primarily experienced by the healthy. At West Shore, a mere 4.6% of the building is dedicated to non-departmental circulation.

More opinions do not equal more solutions
We’ve built our design process to be as inclusive as possible, tailored around user meetings and soliciting approval from all parties involved. Because the hospital will outlast all of its employees, we need to be sure to weigh opinions that impact long-term operations, as much – or more than – individual preferences. It took courage from the senior administration at PinnacleHealth to make decisions on behalf of all of their departments, and it took exceptional streamlining in the decision-making process to meet an aggressive schedule. The success of the project is a result of the vision of their leadership.

Don’t start with a blank slate
As designers we know how to design hospitals, and yet we show up to the first meeting with a blank piece of paper as if we know nothing. (Again, we crave inclusivity.) However, this can encourage people to set unrealistic expectations for the project, what can be accomplished, and, most importantly, what fits in the bubble. Starting the planning with a detailed first pass can focus the conversation. As proof of this, we were able to design an entire hospital with only ten design meetings with the client. We deviated very little from our first pass, and what we know today is that the efficiencies of West Shore Hospital have contributed to the lowest full-time equivalent (FTE) per bed ratio of any hospitals in the PinnacleHealth system.

Sometimes finished is more important than perfect
It may be surprising to some, but the bulk of our activity is often not the actual planning or design, but the iterative process of customizing the design for users. This pursuit of perfection in meeting all project demands equally, whether essential or not, causes us to toil through many late nights. The need to condense an entire design and construction process down to only 24 months helped us realize that sometimes getting the design process finished is more important than getting the design finely tailored.

Ultimately, the intrinsic value of the design profession is our ability to assist clients in the creation of an environment that enhances the way they execute their unique services. For our healthcare clientele, this translates to an environment that provides not only the spatial refinements to promote healing, but the raw performance and infrastructure necessary to execute medicine.  While windows and finishes matter to patients, of greater importance are the simplest provisions of architecture, such as providing enough power in the right place and sufficient lighting.

The mission for West Shore was not about winning awards. Above all else we’re proud that West Shore excels at its most primary mission: to maximize patient care for the money spent.

Matt Eastman is an architect, primarily focused healthcare industry.  

In an age of increased accountability for patient outcomes, every dollar spent on facility construction is one less dollar spent on the staff and technology

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