Design is Like Healthcare...

I call it the “duh” moment- when someone can frame an issue in a way that is so obvious that it inherently makes sense.  You wonder how you never came to that conclusion on your own.  I experienced on of those moments today while reading Scott Simpson’s “Change of  State in A/E/C” for Design Intelligence. It compares the sea change going on in our world to the one that has and is still occurring in healthcare. Doctors and hospitals are “always” kind of things that we will never stop needing, but the particular services they provide and the way in which they deliver them has changed. Sound familiar?

The piece particularly resonated for me because I have a foot in both worlds as an architect who specializes in healthcare. Like many physicians and hospitals, our industry has been slow to move from a traditional cost-based, risk adverse model. We are annoyed that our value or expertise is questioned and rush to create defensive contracts or lobby for legislation that will protect our design processes. What we don’t do is stop to consider whether these processes even still serve us. As Simpson puts it, “there’s not much evidence that all of this management and monitoring is being used strategically to design better buildings or deliver them more efficiently, which is what clients really want.”


Simpson does a great job at projecting trends from the demise of mid-size firms to the rise of multidisciplinary project teams. It’s a futurist view, but an instructive one that I hope will inspire you to look beyond the way things are and start looking at how you can be a leader in delivering:


Architects now have to sell their expertise and value instead of their time
Outcomes matter more than the services provided, value does not equal cost. Simpson cites the example of physicians, who are the primary deliverers of care. At one time, physicians determined how they would treat patients and were paid unquestioned for the services they provided. Today, many have become employees of large health systems and the care protocols that they use are largely dictated by insurance company requirements, which are increasingly being tied to outcomes for the patient. Similarly, architects have focused on being compensated for time or as a percentage of the construction cost for producing a design product. We want our talent to act as the justifier for our decisions. Architects need to have a much broader understanding of what their clients value as well as a way to frame every decision within that context. Start framing the services and expertise you provide as a series of value-adds and tying financial incentives to your ability to deliver according to metrics that are important to the owner (lower maintenance costs, better building performance, etc.). Far from diminishing design freedom, this practice will actually justify in real terms what has in the past seemed arbitrary or purely aesthetic.

Teams, not firms, will design, document and deliver projects.

Just like the once-dominant general practitioner has now become only one member of a team (not all of them physicians) of specialists who manage a patients health, so too will the architect be perhaps the owner’s guide, but certainly not the only player in determining what’s best for a project. You wouldn’t go to a doctor who routinely performed tests without confirming with your insurance company that you had coverage, or who refused to give you access to specialists when needed. It’s the same in design. The standard focus on phases of design and bidding will become irrelevant as technology allows more sophisticated modeling of options. Into the funnel will go decisions about design, sustainability, schedule impacts, operating costs, return on investment needs, outcomes on user experience and out will come a determination of value. This will happen for multiple scenarios throughout the project and the entire team, including the owner and their stakeholders will weigh the options to select the one providing the highest value. Look for more collective contracts and increased emphasis on integration and collaboration. Better yet- suggest them and become an influencer of their content.

If you don’t lead the change, the change will lead you

Physicians have become marginalized by the business of healthcare. Although they still play a critical role, that role is no longer dominant as other players like insurance companies, government agencies, equipment manufacturers, lawyers, and the corporate structures that manage large health systems have come onto the healthcare scene. The solo practitioner with an independent practice who referred patients to the local independent hospital is a relic in today’s healthcare environment. Architects should learn from their medical counterparts that resisting change diminishes your power to shape it. My favorite quote from the piece nicely sums up the issue, “The irony is that architects, who are so good at inflicting change on others, are woefully reluctant to embrace change in their own practices.” Change or become irrelevant.