The business case for better buildings.

The buildings in which customers receive services are inherently part of the service experience. Given the high stress of illness, healthcare facility designs are especially likely to have a meaningful impact on customers. In the past, a handful of visionary "healing environments" such as the Lucille Packard Children's Hospital at Stanford University in Palo Alto, California; Griffin Hospital in Derby, Connecticut; Woodwinds Health Campus in St. Paul, Minnesota; and San Diego Children's Hospital were built by values-driven chief executive officers and boards and aided by philanthropy when costs per square foot exceeded typical construction costs. Designers theorized that such facilities might have a positive impact on patients' health outcomes and satisfaction. But limited evidence existed to show that such exemplary health facilities were superior to conventional designs in actually improving patient outcomes and experiences and the organization's bottom line. More evidence was needed to assess the impact of innovative health facility designs. Beginning in 2ooo, a research collaborative of progressive healthcare organizations voluntarily came together with The Center for Health Design to evaluate their new buildings. Various "Pebble Projects" are now engaged in three-year programs of evaluation, using comparative research instruments and outcome measures. Pebble Projects include hospital replacements, critical care units, cancer units, nursing stations, and ambulatory care centers. The Pebble experiences are synthesized here in a composite 3oo-bed "Fable Hospital" to present evidence in support of the business case for better buildings as a key component of better, safer, and less wasteful healthcare. The evidence indicates that the one-time incremental costs of designing and building optimal facilities can be quickly repaid through operational savings and increased revenue and result in substantial, measurable, and sustainable financial benefits.