Healthcare improved outcomes by systematizing patient records, and healthcare facilities design and construction stakeholders can do the same for the building record. | Photo Credit: Generated using OpenAI (ChatGPT)
By Becky Holden
Not so long ago, our health planning relied on scattered fragments of data. A patient with a complex condition rotated between physicians, with each capturing pieces of information but none of them reliably connecting. Seeing the whole picture of someone’s health was difficult, and critical findings too easily slipped through, like a lab result that would have changed a diagnosis, a life-threatening allergy or medications that shouldn’t be mixed.
Then came a system of record. The electronic health record (EHR) structured, organized and connected those fragments. The pieces came together into one picture of the whole person. Before EHRs, the patient was the system. They carried their record folders from office to office, repeating their medical history for every physician and hoping they didn’t forget anything.
That is the job we hand a health system’s construction project manager today. They are the guardians of the building requirements’ source of truth that is scattered across clinical, operations, IT, facilities and countless consultants.
The design of some of the most complex, high-stakes buildings in the country is governed by disconnected snapshots of information and building design standards that are typically found in PDFs and shared-drive files. We have a system for recording and connecting holistic patient data; now more than ever, we need a system for continuously improving how we build.
The Waste is Real
Health systems in the U.S. spend roughly $70 billion a year on construction, and by common estimates as much as $10 billion is lost to preventable design-related waste resulting in rework, change orders and project delays. This waste stems from requirements that were ambiguous, outdated or scattered across documents that don’t talk to each other.
The owner isn’t the only one who pays. The architects, engineers and consultants inherit the same problem. They are asked to design against unclear requirements that shift and surface late in the design process, eating into design fees. A governed standard is a win for all sides of the project table; it gives design teams a solid foundation to do their best work for the health system.
There is one thing we can be certain about in healthcare design and construction, and that is change. Building requirements come from many directions, stakeholders and entities, and they are constantly evolving. Without a system to structure and govern their evolution and track the enforcement across projects, this data quickly degrades. There are thousands of design decisions on a hospital project with hundreds of stakeholders that all need to connect. A single missed connection can result in a multi-million-dollar design fail.
Data governance stops costly failures from repeating, but it also creates opportunities to align for significant improvements towards your goals. In healthcare, the stakes are higher when it comes to failure. Delays and building downtime are paid for in deferred patient care, higher construction costs and lost revenue.
Living Systems
A document captures a snapshot, but knowledge is an interconnected, living system. Standards need systems to:
- Create – Structure requirements and information so that you can find and connect it across ongoing projects.
- Govern – Give every standard an owner, an approval path and a version history, so anyone knows which version is true and who is accountable.
- Enforce – Provide baseline design requirements for every project, so the right requirement is the path of least resistance. No project starts from scratch, and deviations go through approval.
- Improve – Projects and stakeholders generate lessons that help the next project.
AI and Data Governance
Artificial intelligence is only as good as the data beneath it. Structured, governed standards are the infrastructure for better design decisions that are grounded in evidence and experience.
With a reliable foundation, software can finally do real work: cross-check a requirement against FGI guidelines and building codes, identify a conflict before it becomes a change order and improve outcomes one project at a time.
The Building Record is Next
Health systems are accountable for how their facilities perform over their life, how their typical rooms are configured, what equipment standardizes across campuses and how their IT closets will be configured in 2030. None of that is in the building codes or the architect’s files. It belongs to the owner — yet in most health systems it has never had a home.
Patient care did not evolve with better filing or one-off custom solutions. Health systems adopted a shared, industry-wide system of record. The time is now for design and construction to advance with a system for building records.
Becky Holden is the Founder of Kaizen Design.