George Mann, veteran Texas A&M University architecture professor, says the Affordable Care Act and growing emphasis on sustainability provide an opportunity for health care facilities to better serve patients and cut costs. | Interviewed by Jeff Ferenc
What is the future of health care facility design and how will the Affordable Care Act impact design?
Mann: New hospitals will have to be extremely efficient in terms of square footage, and the heating, ventilating and air-conditioning systems and their costs. New sources of energy and devices such as solar panels and wind power will have to be developed further and utilized.
There will be many new people entering the system after the Affordable Care Act takes effect and we will have to accommodate them. We can accomplish that through greater emphasis on preventive care at community comprehensive primary care centers, which will open in response to the ACA. The primary care centers could be located at places of work, on school grounds, near a church, or within shopping centers.
Are existing hospitals, especially the new, larger facilities, suited to meet the demands of the evolving care delivery system?
Mann: We need both large hospitals and smaller primary care facilities to have a comprehensive network of balanced care. I believe that they will have to work together in comprehensive health networks.
The major elements of a network involve a primary care center with no beds, a community hospital and a university teaching hospital, as well as various-sized facilities in between as they operate in a network.
There's a big investment in new hospitals. And one must have large up-to-date and well-equipped critical care hospitals to be competitive and to attract specialists for open-heart surgery and other complex procedures. So I do not believe these big hospitals will or can go away.
Some experts argue that hospital systems need to do a better job of pushing services out to where patients live rather than deploying a centralized model. How can today's facilities be better utilized if this comes to pass?
Mann: The large facility has to take a proactive attitude and reach out through the network of these smaller facilities to reach the community. The nature of that varies according to the geography of the area. The mission and mindset of a comprehensive health care network and the major hospitals within that network need to be first to prevent disease, and then if disease occurs, to treat the disease efficiently, effectively and swiftly.
What needs to change about hospital design to maximize energy use and become more sustainable?
Mann: When architects design a hospital, they have to realize it's not just the millions of dollars to build a facility that are involved, but it's also the money it's going to cost to operate the facility over its life cycle. They have to design features that reduce operating costs.
That leads us into sustainability issues, sun orientation, the color of the building and the fenestration. The way it is conceived impacts the operating costs, which can be huge.
Common sense says you don't leave electricity running 24 hours a day when the room is not occupied. You can install sensors to turn off lighting. There are more efficient uses of fuel.
There is not only sustainability in construction and operation, but also sustainability in how materials get delivered to the construction site, where they come from and how they're used.
We think of the completion of a new hospital as a heroic moment. However, too often, not enough thought is given to life-cycle costs of operating the facility. We can learn from other cultures as to how they accomplish so much more with a lot less cost.
What specific lessons can U.S. hospitals learn from their overseas counterparts when it comes to facility design and operations?
Mann: Design simple buildings, use local materials and install natural ventilation where possible. Sustainable design lowers construction and operating costs. Use appropriate design and materials for the local climate so that heating and cooling costs can be controlled. Be smart with building orientation. Be aware of colors of building materials — dark to absorb heat in cooler climates, light to reflect heat in hotter climates. Utilize sun shades and overhangs and also rainwater harvesting.
What is the best way to approach hospital design?
Mann: Architects often are educated in a somewhat simplistic Manner — and that is by designing a building it will solve a problem. Often it does; yet, often it can compound a problem and lead to bankruptcy, if a team undertaking the project is not truly interdisciplinary and is not considering the overall problems.
Architects need the help of public health professionals, demographers and statisticians to develop feasibility studies for designing health facilities. Health resources should be responsive to the existing health problems and the causes of illness and death.
Doctors, physician assistants and nurses need to be aligned with health networks and facilities. There needs to be an overall strategy of coordinating health manpower, resources and facilities that adds up to an overall strategy in fighting diseases.
We need to develop comprehensive strategies to prevent disease, have early diagnosis of disease, effective treatment and follow-up rehabilitation, and effective home care to keep people out of the hospital as much as possible. Many of these tests and interventions can take place in local community primary care centers.
What is the level of interest in health care facility design among students today?
Mann: Interest is very high, especially among international students. I think an ideal program is a mix of domestic and foreign students. When our American students are exposed to students from other countries they are exposed to future opportunities and collaboration. They are maybe exposed to other ways of doing a project other than, for example, building all single-patient rooms.
I am so proud of the accomplishments of our Texas A&M graduates who have made enormous contributions to state-of-the-art health care facility design all over the world, since this unique program was established in 1966. These accomplishments are living proof of the need for such a specialized program.
The Mann File
- The Ronald L. Skaggs, FAIA-endowed professor of health facilities design, College of Architecture, Texas A&M University, College Station.
- First to hold Skaggs-Sprague endowed chair of health facilities design.
- Director of the International Union of Architects/Public Health Group, president and co-founder of the Global University Programs in Healthcare Architecture.
- Founder and advisory board chairman of the Resource Planning and Development Group.
- Directed the design of more than 700 health care facilities and hospitals and consulted on many other projects throughout the world.
- Taught more than 4,000 health care facility architectural students over 47 years, many of whom now practice at leading design