The Building Is Not the Asset

Health care architects have a problem that is shared with radiology administrators and others directly involved in building new space for radiology. Design and construction projects are often marked with busted-budget angst, the bricks-and-mortar version of having eyes larger than your stomach. All of the focus on the cost-per-square foot (and squeezing $10,000 out of the project here and $50,000 from over there) reinforces the fallacy that the millions of dollars spent on radiology facilities makes the buildings valuable. Watch out, because I’m about to say something that will alarm nearly every health care architect and radiology administrator…

Your buildings, your posh waiting rooms, your high-tech imaging suites are worthless!

OK, maybe ‘worthless’ is a bit strong. There is undoubtedly some real property value for the commodity represented by the dirt the buildings sit upon. But the building itself is not where the value lies for radiology providers.

The value of a health care practice lies in the quality of care you provide your patients and the numbers of them you can care for. Can technology improve quality and quantity of imaging services? You bet it can! But patients won’t flock to an outdoor 256-slice CT. Imaging providers must have facilities in order to support the technology and operations.

I just did something sneaky… did you notice? I told you your building isn’t valuable and then took you on a logical walkabout to come back to recognizing the necessity of the building you have. So, are we back in the same place we started? Not if you followed my argument. Too often we focus on the size, the cost, the color, the “prettiness” (for lack of a better word) of our buildings and we fail to recognize them for what the value they ultimately provide.

The building for a radiology department or imaging center fails if it doesn’t recognize and support best-practice operations that occur inside. If we figure out how we should work to care for patients, then break down each step of “work” to know where we need the patients, caregivers, support staff, imaging equipment, waiting rooms, writing surfaces, storage areas, bathrooms, etc.…then we begin the process of building an environment of care.

This is not intended to be a license to spend money on building projects like you were printing Ben Franklins in your basement. It’s not an issue of ignoring the budget, or the available space, or existing staffing limitations, but rather settling on an ultimate objective and figuring out how your facility can, in some small measure, get you closer to where you really want to be.

When it comes right down to it, hospitals and imaging centers don’t get reimbursed based on the comfort of their waiting room chairs or how impressive their front door is. They get reimbursed for patient care. Maybe comfy chairs and impressive entrances are important parts of the experience for your patients and warrant an added degree of attention. But designs for new facilities, additions, or even just a single equipment replacement, should focus first on the objectives of patient care.

For facility managers, architects, engineers, equipment planners and even radiology managers facing capital improvement projects, there will be ample pressure to conform to budgets, space and timelines. To achieve an end result that you are truly proud of, you may need to coax your entire collaborative team to throw off these mundane considerations—for at least a little while—and address the bigger picture issues of who you are serving and how.