How Do We Find the Right Architect?

Andrew M. Ibrahim MD, MSc is the Maud T. Lane Research Professor of Surgery, Architecture and Urban Planning and Vice Chair of Surgery at the University of Michigan. He previously spent 6 years as the Chief Medical Officer and Senior Principal of the global design and architecture firm, HOK.

January 2024

A friend of mine is the CEO of a health system and recently asked a fairly simple question, "We're about to build a new hospital... how do we find the right architect?" I couldn't resist. I ended up sending him a long email, that's now summarized below. Hope you find it helpful!

AMI

Each year in the United States we spend >$48 billion building healthcare facilities. At any given moment, about half of the health systems in the US are actively executing or planning their next capital project. An essential part of the process is choosing the right architect. Here are six strategies to help healthcare leaders attract and select the architect that will best deliver the building your health system needs.

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1.???? Early exploration of alternatives

When healthcare leaders are faced with challenges such as “not enough beds” or “not enough parking”, their instinct is to build. In many cases, that may be the right answer. But healthcare facilities are expensive, take years to execute, and in many scenarios a building will not actually solve the problem. For example, parking and capacity constraints may be addressed by: shifting specific procedures to a different days of the week to smooth out high demand; selective use of Saturday operating rooms; or by leveraging nearby sites of care.

?Not surprisingly, most architecture firms over time have developed robust consulting practices. Essential to the work is figuring out if you even need a building in the first place. Consider hiring such a consultant before going on the journey of building a new facility.

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2.???? Get a handle on the phases of design and know where you fit in

For all of its creativity and complexity, the process of designing and constructing a new hospital facility is actually quite predictable. ?In general, most projects have seven stages and each focus on a specific question:

·????? Pre-Planning and Master Planning: Do we need to build?

·????? Programming: What do we need?

·????? Schematic Design: Where does it all go? What does it start to look like?

·????? Design Development: What goes into each room?

·????? Construction Documents: How are we going to build it?

·????? Construction Administration: Does the design match the actual building?

·????? Post-Occupancy Evaluation: Did it all work out the way we thought once the building is occupied?

Knowing what is happening in each phase can help you decide where you want to insert yourself (or delegate) and guide important decisions. The most successful projects often find a way to keep senior leadership engaged at least through schematic design and design development. (If you want more details on the process, and the tools used during each phase, you can download a free PDF primer, here .)

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3.???? A Not-so-Selective initial Request For Qualifications.

Many healthcare systems, when looking for an architect, will start with a request for qualifications (“RFQs”). The idea here is make sure the architecture firms being considered have enough experience and expertise to pull off a healthcare facility. Healthcare projects can quickly become complex, so this tends to be a pretty quick “weed out” phase.

One down-side of a very rigorous RFQ process is that it tends to result in a short-list of the same firms over and over. While these firms are excellent, they can also be over-extended and more entrenched in historical conventions on healthcare facilities design.

My advice? Make the RFQ far less selective and see who applies. You may be surprised by a new firm and how they might approach your project. If they have the right design you are looking for, but not the needed technical expertise, advise them to team up. More and more, architecture firms with complementary expertise are teaming up to delivery complex healthcare facilities. See two current examples here from UCSF (designed by Herzog & de Meuron & HDR ) and Mayo Clinic (designed by CannonDesign & Foster + Partners ).

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4.???? Limit the Interview Team.

Once you have worked through the RFQs, you will move on to a Request for Proposals (RFP) and Interviews. I always found this an incredible process. Everything that a client says is important in the RFP will end up in the interview. If the RFP states the client wants someone who can design airports to influence this hospital (real example, btw), the architecture firm will bring that expert to interview day to weigh in. Ask and you shall receive!

But the interview day can be a misleading experience. Architecture firms, in an eagerness to impress, tend to bring a lot of people to the interview. So what’s the problem? That may not be representative of who you will actually work with you throughout the life of your project. While if differs for every project, most projects have a core team of 4-8 people who will connect with the client regularly and throughout the duration of the project. These are the people you want to meet on interview day. To get a better sense of what things would look like, limit how many people the firms can bring to the interview. Even better, specifically ask for the people who will be most deeply involved throughout the life of the project.

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5.???? Ask about Evidence.?

Much like healthcare itself, the design of healthcare facilities is increasingly being informed by a growing knowledge base of evidence. The Center for Health Design (full disclosure, I sit on their board) is a great non-profit that aggregated and updates importance research evidence to inform better hospital design.

Ask each firm how they engage with emerging evidence and incorporate it into their design. Is there anyone in their firm formally trained in research to help find and apply the best relevant evidence? It can become an important differentiator.

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6.???? Take the long view.

Even the most straight forward healthcare facility can take 2-3 years to construct, with larger ones averaging 6-8 years. While there is a lot of eagerness and anticipation for opening day, take the long view. More than getting through the process (which is definitely a long journey!), you actually want to know, “did this building work that way we hoped it would when we designed it?”

Architecture has a name for this moment: a post-occupancy evaluation. The general idea is that after a building is occupied (e.g. say for a year), you then go systematically evaluate how well it is performing. While this was previously thought to be irrelevant because these facilities were once in a generation project, the growth of health systems into mutli-hospital networks means they often have several projects running. As such, the completion of one project may be the perfect time to gather evidence as that same client is starting their next project. To add more teeth and accountability to the process, you may even consider putting part of the financial contract with your architect and builder at-risk based on the results of the 1-year post-occupancy evaluation.

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These six strategies are not exhaustive, but hopefully a start to get you thinking about ways you can better position yourself to choose the right architect for your project. Look forward to the conversation below on how others are guiding their clients to navigate the process of designing a new healthcare facility.