Professional Responsibility: Lessons Learned from an 8-Year-Old
My 8-year-old daughter has it bad. She's the youngest of her in-town cousins by 7 years. She's an only child. At recess, often she prefers to hang out with her teachers or parent-helpers than with her classmates. She's smart and picks things up very quickly. She thinks she's on the verge of total independence. The message I keep repeating to her, however, is that independence and responsibility go hand-in-hand. This is a difficult lesson to get across when there are so many high-profile exceptions to the rule.
I suspect that I approach pariah status with some of my former professional colleagues. Until a few weeks ago, I was working in an architectural firm and I was not too subtle about the fact that I felt that design professionals (architects and engineers) weren't living up to their professional responsibility when it came to radiology design. This isn't a universal truth, but there are innumerable examples of hospitals and imaging centers that were code-compliant, yes, but concrete testaments to designers' ignorance of the technical, operational and financial realities of medical imaging. Architects have shed massive quantities of responsibility without similar levels of independence.
Well, perhaps they haven't shed responsibility, but they certainly haven't kept up with changes in the technology and clinical care that continue to ramp-up. Just look at the differences in throughput with conventional film versus digital radiography (DR). Architects see an X-ray machine. Compare the patients examined in a single-slice CT a dozen years ago against who we're scanning in a contemporary 64-slice.
It used to be that your design professional would tailor unique design responses to a client's specific needs. Often they would insinuate themselves into your organizational structure during planning to learn as many of the unspoken needs and desires as they could. They would work hand-in-glove with the manufacturers and contractors to determine the best way to sculpt a facility in response to these goals while working to make the facility attractive and durable.
Today, much of radiology design is copy-and-paste from design templates or vendor "typical" installation guides. By and large, architects don't get how PACS reshapes workflow or how the increasing use of radiology as an interventional platform should change decade-old stock designs. Fifty-year buildings are built making equipment that will need to be replaced on a 7 to 10 year increment inaccessible, as if that new MRI is supposed to last until 2055.
There are a number of reasons why many in the design professions have slipped back to where my 8-year-old is. Many who buy professional design services see them as commodities and there has been a "race to the bottom" to cut fees as far as possible. Some professional design fees are half--as a percentage of construction costs--of what they were 20 years ago. Architects have had to pare services accordingly and now rely on product and equipment manufacturers to spoon-feed them canned design solutions. For many designers, even if they wanted to provide the service that only comes from an intimate level of technical and operational knowledge, their own throughput pressures make it difficult to dedicate that quantity of attention to a single client or project.
To no small degree, we've allowed genuine knowledge and expertise to give way to market positioning and PR. Face it, health care is a profoundly complex enterprise yet we rarely balk when we see firms market themselves as "health care design experts." Larger firms may be able to put together "all-star" teams of design experts who really do represent the best and brightest for ERs, patient rooms, ICUs, ob/gyn, ORs and radiology, but the notion that any one person could effectively be an expert in the design of more than a couple areas within the hospital is laughable.
Radiology facilities planning capital projects need to map out their expectations of their design team before they even begin shopping for a designer. Those expectations must be clearly spelled out and communicated to prospective design consultants. Radiology services are simply too valuable, both in terms of clinical care and financial investment, to fail to define one's expectations and effectively vet the professionals you hire.
To be sure, by expecting more you are likely setting yourself up to pay more for the services. But when you compare the cost of professional design services to the value of the radiology services they can facilitate (or handicap), differentials in professional fees are inconsequential.
The larger battle, however, may not be in justifying a fractional increase in fees, but rather in getting a design team to step up and assume the increased level of responsibility for their clients' outcomes. Radiology providers, however, need to set the expectations. Failure to do so when in hiring skilled designers--as it is in raising my daughter--will result in aggravations that will last for many, many years.