Fable Hospital 2.0: the Business Case for Building Better Health Care Facilities (Essays‪)‬

Despite deep and vocal disagreements over health care reform, virtually everyone believes that the current system is not economically sustainable. We are spending too much and getting too little in return. This recognition has spurred health care leaders to examine every aspect of hospital operations. But what about the health care building itself, the physical environment within which patient care occurs? Too often, cost-cutting discussions have overlooked the hospital structure. Changes in the physical facility provide real opportunities for improving patient and worker safety and quality while reducing operating costs. The "Fable hospital," an imaginary amalgam of the best design innovations that had been implemented and measured by leading organizations, was an early attempt to analyze the economic impact of designing and building an optimal hospital facility. (1) The Fable analysis, published in 2004, showed that carefully selected design innovations, though they may cost more initially, could return the incremental investment in one year by reducing operating costs and increasing revenues. Reactions to the Fable paper varied. Many felt it presented a compelling case and stimulated health care leaders and architects to think differently about balancing onetime building costs with ongoing operating costs. Others voiced skepticism about whether the benefits were as great as described and asked for more evidence.