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Essay
Fable Hospital 2.0: The Business Case for Building Better Health Care Facilities The first of four essays on how design benefits patient care and business.

Too often, cost-cutting discussions in health care have overlooked the health care building itself, the physical environment within which patient care occurs. Changes in the physical facility provide real opportunities for improving patient and worker safety and quality while reducing operating costs.

The “Fable hospital,” an imaginary amalgam of the best design innovations that had been implemented and measured by leading organizations, was an early attempt to analyze the economic impact of designing and building an optimal hospital facility. The Fable analysis, published in 2004, showed that carefully selected design innovations, though they may cost more initially, could return the incremental investment in one year by reducing operating costs and increasing revenues. Today, the Fable hospital is no longer imaginary. During the past six years, numerous hospitals have implemented many of its attributes and have evaluated their impact on patients, families, and staff.

It is time for a fresh look at the Fable hospital. Drawing on the latest design and health care knowledge, research, the 2010 health reform law’s emphasis on value and quality improvement, and our collective experience, we present Fable hospital 2.0.

Too often, cost-cutting discussions in health care have overlooked the health care building itself, the physical environment within which patient care occurs. Changes in the physical facility provide real opportunities for improving patient and worker safety and quality while reducing operating costs.

The “Fable hospital,” an imaginary amalgam of the best design innovations that had been implemented and measured by leading organizations, was an early attempt to analyze the economic impact of designing and building an optimal hospital facility. The Fable analysis, published in 2004, showed that carefully selected design innovations, though they may cost more initially, could return the incremental investment in one year by reducing operating costs and increasing revenues. Today, the Fable hospital is no longer imaginary. During the past six years, numerous hospitals have implemented many of its attributes and have evaluated their impact on patients, families, and staff.

It is time for a fresh look at the Fable hospital. Drawing on the latest design and health care knowledge, research, the 2010 health reform law’s emphasis on value and quality improvement, and our collective experience, we present Fable hospital 2.0.

Blair L. Sadler, Leonard L. Berry, Robin Guenther, D. Kirk Hamilton, Frederick A. Hessler, Clayton Merritt, and Derek Parker, "Fable Hospital 2.0: The Business Case for Building Better Health Care Facilities," Hastings Center Report 41, no. 1 (2011): 13-23.