Design and Health World Health Design

Health Record: In Praise of Appraisal

The best way to see how a new building is performing is to evaluate it, says Paul Willetts. So why do so many healthcare providers choose not to bother?

As German philosopher Friedrich Hegel said, “The only thing we learn from history is that we learn nothing from history.”  Is this the reason that the number of Post Project Evaluations (PPEs) carried out on healthcare buildings in the UK is so woefully low?

It’s no different in other countries, where despite signifi cant investment in healthcare, there’s still insufficient rigorous evaluation. Figures from the World Health Organisation for 2005 show the US spent 15% of GDP on health, Bolivia 7% and UAE 2.5%, and over the last 10 years in the UK alone, investment in healthcare buildings has been £3.2 billion.

In over 25 years in the UK’s National Health Service, initially as a clinician and then in senior management, I am one of relatively few clinicians and managers who has enjoyed the challenging but rewarding process of helping deliver and evaluate a new hospital. Members of staff naturally focus on the delivery of a project, and when achieved, it’s easy to see why evaluation gets overlooked.

If, like Winston Churchill, you believe that “the farther backward you look, the farther forward you see,” and you agree that continuing to improve the design of healthcare facilities is essential from a clinical, environmental and financial perspective, then the challenge is to evaluate all health projects delivered.

In the US, PPEs originated during the 1960s for public housing and are now found mostly in the government sector and large businesses including the US General Services Administration, US Courts, United States Postal Services and Disney, where they are used for building portfolio management and organisational learning performance1. The 1970s witnessed the first major collaboration between architectural and medical professionals in hospital design2. During the 1990s, PPE tools were used to develop accountability measures.

Joiner3 discusses the growth of PPE in New Zealand, where government architects, until then, used accounting and engineering measures (principally time and cost) to demonstrate performance. Here, PPE has developed as a process offering social negotiation between stakeholders of a building project.

US architectural practice HKS has developed Functional Performance Evaluations – analogous to PPEs – specifically for healthcare buildings. In the UK, the Department of Health has always been clear about the hospitals’ responsibilities for PPEs and states they are “an essential aid to improving project performance, achieving best value for money from public resources, improving decision-making and learning lessons,” and are “mandatory” for virtually all projects.

So how do we create incentives for health bodies to carry out evaluations? Perhaps an independent architect should take the lead, or there could be an annual award for the most clinically, architecturally and environmentally pertinent evaluation. Maybe they could be offered a financial incentive.

We’re deluged with information of all kinds, but there’s simply not enough on how healthcare buildings perform. It’s important to share PPEs to build a global best practice knowledge bank, and given the investment in hospitals – and the fact that they deal with matters of life and death – they are crucial buildings to get right.

1. Pati, D. Maximizing the benefits of courtroom POEs in design decision support and academia inquiry through a unified conceptual model, Georgia Institute of Technology; Ph.D. dissertation, Atlanta, USA; 2005.
2. Preiser, W.F.E., Rabinowitz, H.Z., and White, E.T. Post-Occupancy Evaluation. New York; Van Nostrand Reinhold; 1988.
3. Joiner, D. User Participation: POE Practice. In G. McIndoe (Ed.), Building Evaluation Techniques (pp. 85-89). New York: McGraw-Hill; 1996.

Author: Paul Willetts is healthcare director of Ryder Architecture

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