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The Pebble Project ten years on: what next for healthcare design?

Wednesday, 1 December 2010

What does it mean to have worked on one of the first Pebble Project hospitals – before there was a Pebble Project?  It’s a funny dynamic of simultaneously looking forward and back. How can we use innovative design to enhance the quality and cost-effectiveness of healthcare delivery today, in an era of lean operations and healthcare reform? How can research conducted on those innovative projects more than a decade ago inform design today?

When Shepley worked with Bronson Methodist Hospital on its replacement hospital in the mid-1990s, there really wasn’t an evidence-based design movement and certainly not much evidence to guide the design team. We based design decisions on guiding principles, such as placing the patient first and (sometimes literally) in the center of care, and the opportunity and desire to use the replacement hospital to reorganize and redesign care delivery and test the effectiveness of these decisions.  In retrospect it seems clear that many of Bronson’s design elements – the single patient room, decentralized nursing, healing gardens, emphasis on wayfinding – were the right call, improving patient outcomes as well as patient, family and staff satisfaction. They were also precedent-setting, and today are considered standards of contemporary hospital design.

Here’s the big question ten years after the first Pebble Projects: what’s the ideal relationship between evidence and innovation?  It’s one thing to help an owner understand the potential implications of design options and another to imply that the best way to design is to simply aggregate all the “most proven” solutions and be done with it. There’s no innovation if designers follow the second model and so no opportunity to reinvent and innovate – no opportunity, in fact, to create the next Bronson.

- Jennifer Aliber

Jennifer Aliber AIA, ACHA is a principal at Shepley Bulfinch and a leader of the firm’s healthcare practice.

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