Sunand Prasad makes an insightful point about the need for long-term thinking in architecture in general and healthcare in particular.
We recently opened our second hospital built from scratch, in Reading. As with our first hospital, CircleBath, we set our team a simple goal: “Redefine what a hospital should look and feel like while reducing what it should cost.”
We told them everything is acceptable except the conventional. No need to say, this did not make us popular.
We asked many basic questions. Some were big like: why isn’t beauty a priority in the places we send people in their hour of need? Why not spend more at the start to make our hospital sustainable at the end? Some question were small: why do we accept cold linoleum floors when we will never allow them in other places of hospitality (our homes, restaurants, hotels)? What is wrong with wood flooring? Why do we choose low ceilings that give a claustrophobic sense of space?
For every such question, we had armies of accountants, planners and surveyors telling us why it could not be done. In Bath, they told us “this isn’t the way it’s done in hospitals”. In Reading, they said “this isn’t the way it’s done in Bath”.
It was tough winning those battles, but with “scars to show for in our backs” we won enough.
Our very first building recieved many awards, including one for the best building in the UK and one for the best public space globally. How could a group of people who have never built anything before win so much? The answer is simple and has nothing to do with building. It is, as Mr Prasad describes it, all about clarity of demand. Leadership is a really tough job precisely because it is about zealously refusing to compromise on what matters while navigating through what is required.
As Mr Prasad points out, too often in both the public and private sectors, zeal for financial success has overtaken quality and beauty. But the two are not mutually exclusive. CircleReading cost £2,600 per square meter to build, significantly less than the norm for a full surgical hospital. This is because while our team knew they could make no compromise on the key areas of quality that delights patients and staff, they were expected to get the extra money from relentlessly re-engineering every other line of cost. So we spent more, a lot more, on things that mattered in the long term, but were brutal on processes, wastes and procurements that made little strategic difference.
The biggest challenge in healthcare today is about reengineering value, and as we say often in this column, value in economic terms is a function of quality over price. Quality in healthcare is the sum of clinical outcome and patient experience. Therefore, patient experience matters economically also because according to this basic equation it improves the value for taxpayers and patients.
Of course, this equation calls for a balance between quality and price. But a focus on price without quality leads to a Ryanair economy and robs life of beauty and service.
There is always space for aesthetics, because no matter what we tell ourselves, human DNA is programmed to appreciate beauty. And our job is to cure and care for humans.
Mr Prasad’s interview reminds us to look beyond the day-to-day financial pressures we face, and strive to create long-lasting value. Value is a combination of quality and cost. Like all things in life, this needs balance, and striking the right balance is never easy. But that balance, once struck, will reward again and again.
Ali Parsa is chief executive of Circle