I saw a blog today titled, "Creativity is NOT Innovation." Key take-aways were: creativity is the process of generating something new & innovation is the practical application of creativity. This distinction gets lost in many projects where innovation is a goal. So much creativity and ingenuity is poured into the planning and programming stages, but application of any new ideas is rarely approved. Why is it that so much emphasis on innovation often leads to mediocre outcomes? The biggest answer can be found when you follow the money.
Occupants need to reliably breathe = mechanical systems need to be funded
Toilets should flush somewhere besides lower level above-ceiling space = plumbing needs to be funded
Most stuff needs electricity to work = electrical systems need to be funded
Project press releases need cool photos = bold architectural statements need to be funded
Some inspector might want this unless they’re in a good mood = some good stuff + many things you’ll never use are funded
Porsches park better indoors = parking garage for senior staff needs to be funded
We’ve blue-skyed for years about the potential of data analytics transforming the practice of medicine. We were fascinated (and envious) as other industries reinvented their base practices by mining their own massive data stores, looking for trends and tying management decisions to data-driven predictions. In essence, we are talking about bottling instincts. Every expert has instincts about what’s next or how to manage their business. These instincts draw from years of experience, excellent training, and focus on the right details. In effect, isn’t this recipe for intuition the heart of how data analytics are transforming industries?
And industries that lean heavily on instinct are envisioning the potential of analytics. Law enforcement has began to modify how officers are deployed by predicting criminal activity. Other industries are restructuring supply chain and workforce management based on similar analytic processes. As these businesses shift from reactive management to proactive (and predictive) management, we have rejoiced at the fantastic potential to digitize instinct and catapult the medical practice into a new era. Some time ago, my team enthusiastically engaged with one the world’s largest healthcare technology manufacturers. We wanted to share our ideas and our vision for the future of healthcare. We whiteboarded our concepts eager to hear how this manufacturer could equip our vision. How disappointing it was to hear that our concepts were interesting, but not a priority. This sort of “pie in the sky” notion was supposedly a decade away!
I read a lot, an awful lot. One of the folks I follow is Tony Schwartz (President/CEO of the Energy Project), a terrific writer and thought leader on improving companies by energizing their people. In a recent blog Tony talks about the terrible toll of the fast-paced life. With no time to “relish, savor, or luxuriate”, we relentlessly rush to get the next thing done. For many people, life has become about getting a list of things done as quickly as possible. The end result is a lack of “depth, nuance, subtlety, attention to detail.”
His blog reminds me of a disturbing trend in the architectural-engineering industry. We are well-intentioned, to be sure, but our haste to juggle multiple engagements and meet aggressive (sometimes impossible) schedules has cheapened aspects of our trade. We don’t prioritize or honor time to think. Time to think about longer term benefits to our clients. Time to think through innovative design alternatives. Time to think through how our clients business may evolve creating new demands. The overarching emphasis is on doing but if you haven’t taken time to think through the challenge before you, how do you know your activity is well-directed or worthwhile.
As project delivery methods continue to evolve, I see the de-prioritization of ‘think time’ on a larger scale. By example I’ve worked in lean delivery projects for more than 6 years and you might say I have developed a love-hate relationship. I’m enthusiastic about cutting out waste and improving collaboration across the entire project team especially breaking down barriers between designer and builder. But many of these projects ultimately deviate from the essence of lean and end up rushing to draw or rushing to build resulting in a project that lacks depth, nuance, subtlety, attention to detail. The thought-oriented creative design process is too often undervalued and therefore trimmed down so the team can finally get to the real work: creating deliverables, having lots of meetings, building elaborate spreadsheets, having bigger meetings, BIM modeling, going for permits, building buildings, etc.
Each of these activities have great individual value (except maybe meetings), but how do you know what to coordinate, meet about, and ultimately build if you haven’t taken the time to work through the creative design process?
And let’s not confuse sitting in a meeting brainstorming (a marginally valuable exercise) with dedicating personal time to thinking through design challenges. My consulting team’s best ideas were born in solitude. These ideas matured through collaboration, but the seeds of those innovative concepts were only found when our best and brightest took the time to think. It takes discipline and you will get snide remarks (I sure do from people who “wish they had time to think”), but our greatest tool is our mind. Using it more will save your sanity, save your career, and it might just save this thing called the AEC industry.
37,032 people poured into the Las Vegas Venetian Sands Expo Center to attend the annual conference sponsored by the Chicago-based Healthcare Information and Management Systems Society (HIMSS) http://www.himssconference.org/ . Healthcare reform and improved information technologies have radically increased the need and opportunity for knowledge about potential technology based solutions in the healthcare industry. Prospects abounded; this year’s conference provided over 240 educational sessions, six knowledge centers, specialty symposiums, an Interoperability Showcase, the Intelligent Hospital Pavilion, Specialty Interest Group meetings and 1,038 vendor exhibitors.
"China did not invent intellectual property theft; it’s just doing it on an unprecedented scale." This was one of numerous quotations in a recent article on Chinese industrial espionage. The article went on to describe a predictable but equally chilling history of intellectual abuse and thought theft totaling billions of dollars of intellectual property stolen. One expert described it as the "greatest transfer of wealth in history."
In the United States, more than 540,000 babies are born too soon each year. Immediately vulnerable to their surroundings, the growth and improvement of these infants can be negatively impacted by sound, light, and temperature. In an effort to enable hospitals to better care for pre-mature infants, hospitals have enacted “quiet” time in neonatal intensive care units. How effective are these quiet times and should more emphasis be put on decreasing the acoustics of a typical hospital setting into a NICU?
Where does the noise come from? Spaces are continually crowded and noisy with visitors as well as monitors and alarms. The hospital’s HVAC system can produce low frequency “white noise.” For preterm infants, these disorganized sounds immediately create an experience and an impacting result in brain-development. The sounds and disruption may in turn mask important signals such as the voice of the parent or the simulation of day and night.
In order to reduce stress on infants, hospitals should take great care in the design of their NICU. Padded wallpaper and sound absorbing ceilings and floor tiles, the cycling of soft light from day to night, and lights that flash when noise levels get too high are current ways hospitals are altering their design for a quieter NICU. During quiet time, nurses keep conversations to a whisper and do not report on the infant status at bedside. Parents are encouraged to have quiet kangaroo care with their infant.
With ten to fifteen percent of all newborns requiring care in a NICU, neonatal-friendly design should be highly considered. What do you think is more effective: a few hours every day of intensified quiet or a semi-quiet NICU at all times? What can nurses do throughout the day to reduce noise levels and infant stress?
As Meaningful Use pushes the healthcare industry towards full adoption and integration of electronic health information, the question, about maintaining HIPAA compliance and privacy, arises.
There are many significant reasons for moving healthcare information onto an electronic network, it provides many safety benefits, cost savings and the ability to study the aggregate information. As we share the individual's information we create greater risk for the invasion of privacy. Some say that privacy will be controlled by policy yet we see many instances of how hospital staff accessed a celebrity's health record even though they knew it was against policy and they could lose their job. Unfortunately human behaviors don't always comply with policies.
As we make healthcare information more accessible, we must take steps to insure privacy. It's no secret that some organizations are looking forward to accessing healthcare data for business purposes and opportunities to decrease coverage and increase consumer costs. Where is the line drawn between advantageous business practices and the individual's rights to privacy?
Proponents of making healthcare information accessible to outside parties say the practice is acceptable because the individuals' records have been de-identified. There are many instances however, where anonymous information has been re-identified and the individual's right to privacy has been abrogated. Again, the response is often 'privacy will be controlled by policies'.
As the use of the Electronic Health Record expands, more and more information is being shared into regional and state databases, making it accessible to most other providers. Again, the practice is supposed to be 'access the information only on a "need to know" basis. Again, policies have not proven to be stalwort protections. Some states are adopting an "opt out" level of consent. Their practice is that they can assume all individuals give consent to the release of their records unless the individual provides a written statement refusing the relase of their information. Unfortunately, most people are not aware of this practice and do not realize that their information is being released to outside databases.
The use of EHR is rapidly increasing and with it, the philosophical and legal questions about protecting the privacy of individual's healthcare information, arise. Situations and practices are beginning to be challenged in the court; many of the issues surrounding privacy will have to be interpreted by case law. In the interim, is your information secure? Is your provider's practice sharing your information with a regional or state database? Is your information being made available to third parties? These are questions that your physician should be able to answer for you.
There is so much talk (and fortunately, action too) these days by a lot of smart people about the right way to deliver a healthcare project. We hear traditional (design/bid/build), Design/Assist, Design/Build, CM/GC, CMAR, Integrated Project Delivery (IPD), Integrated Form of Agreement (IFOA), - the acronyms and options are quite staggering and each method brings a different approach. Is there a right delivery method for projects within the healthcare industry? Could there be a one size fits all? Having been in the collaborate “trenches” for all of these project delivery methods, I don’t think there is a one size fits all solution; however I think the trends are certainly pointing in certain directions. I am fan of those delivery methods that deliver the best healthcare, not just the best healthcare project. So, I ask – what is the right way and when do you know it’s the right method for a given project?
At just about every design convention or healthcare conference I attend, the sessions that fill up fast are the ones about the future. Whether it's designing in virtual reality, discussing how nanobots will fortify red blood cell counts, performing remote surgery on the moon, growing replacement organs, or turning a patient room into the holodeck, this is stuff that inspires the imagination and generates a lot of excitement. And why not? It’s cool to talk about wizbangs and gizmos that don’t exist yet. It’s fun to learn about yet-to-be-invented technologies that will change our world.
WIth the increased pressure for employers to reduce costs associated with employee healthcare forcing the creation of Accountable Care Organizations (ACO’s), the bottom line is more people will be insured in the future than are now, and most will be in less dense population areas. We see a shift in healthcare facilities from the large urban campuses, to low‐cost, accessible primary care facilities linking patients and providers via virtual clinics and shifting emergency care out to satellite facilities. Healthcare organizations will invest in infrastructure required for the ACO model, including interconnectivity, patient activation, short‐stay surgical facilities and consolidated imaging centers to maximize asset utilization. With the incentives and penalties associated with Meaningful Use requirements, the IT strategies must find technologies that enhance usages and reduce costs. This includes the use of the cloud that can bring the care to the patient’s home yet also requires well planned owner infrastructure to support critical applications. The model is shifting to a more nimble and cost effective solution.
Creating and maintaining a robust wireless network is a key concern in most hospitals and outpatient facilities these days. More and more of the technology that is coming out for the Electronic Medical Record and patient care are built for wireless connectivity. Wireless is great; it provides the mobility that nurses and doctors need to access and document in the patient medical record. The increase in wireless requirements however, presents its own challenges.
The advent of the Electronic Medical Record has provided new opportunities for clinical documentation, allowing us to decide what is the optimum time and place to enter clinical documentation in a patient record.
Over the last decade, I’ve spent more than 16,000-hours working as part of technology planning teams for hospitals around the world. It has been exhilarating to be part of an industry that was just beginning to glimpse the possibilities of harnessing technology to deliver better services to patients and reduce operational costs. Many of the so-called bleeding-edge concepts and strategies that we pioneered in the beginning have now become standard operating procedure for most western world hospitals. Believe it or not, it really wasn’t that long ago that handing a nurse an IP-phone connected to the nurse call system was called “gold-plated Star Trek” by one hospital executive. Those were the days when the largest deployment of hands-free, voice-activated IP handsets was found in a retail store rather than a healthcare campus. And Wifi was considered a high-end patient amenity! It’s no surprise that entire industries have grown to develop products and services intended to meet the healthcare world’s demand for smarter, better, and faster technologies.
You've heard the term 'high tech - low touch'. Clinicians are often concerned that increasing the role of technology in healthcare will diminish the human interaction and compassion of nursing. Can new technologies improve nurses' work and allow them to spend more time at the bedside with their patients instead of at a central station writing in charts, making phone calls and ordering supplies?
Cloud Technologies, Electronic Medical Records, Point of Care, Clinical, Nursing, Meaningful Use Criteria, Mobile Health, Data Center, Hybrid, Design, Trends, TeleHealth, Acoustics, Vibration