You Can’t Predict What’s Next. You Can Prepare for It.

By Austin B. Delaney, EVP, Technology Design & Advisory

The facility you’re designing today may not open until after 2030. And once it does, it may be a decade or more before a major renovation substantially changes the space.

That means the decisions being made today may need to support a technology environment well into 2040 and beyond.

The challenge is obvious: how do you design for a technology environment you can’t yet see?

Some of the systems, devices and workflows a facility will rely on at opening may not exist yet today. Others will evolve significantly between design and go-live. And the expectations of those using these spaces—patients, care teams, and communities—will continue to change.

The goal is not to predict the future.

It is to prepare the building to adapt.

Start with what the building needs to make possible

One of the easiest mistakes to make early in a project is jumping too quickly to a product or vendor.

What system are we buying?

Who makes it?

What device are we putting in the room?

Those decisions matter. But many of them do not need to be made first.

Early in design, the more important questions are about features, functionality, and experience.

How can technology empower the patient?

How should clinicians work?

What needs to connect?

Where can technology remove friction from workflow?

What does the building need to physically support to make these things possible?

Consider something as familiar as a patient-room display. We may not need to know years in advance which brand will be selected, what the interface will look like or every application that will eventually run on it. We simply need to understand what the display should enable and make sure the environment has the common power, connectivity, infrastructure, and physical coordination to support a broad range of future applications.

The same principle applies at a much larger scale.

If an organization wants to use real-time location technology to change how patients move through an outpatient environment, that strategy could reduce reliance on traditional waiting spaces and allow more space to be programmed for amenities. Self-rooming, digital check-in, or a technology-enabled discharge can influence how space is programmed long before a specific technology product is procured.

Technology is not simply something that gets added to a completed design.

It can change the design itself.

Future-flexible is more realistic than future-proof

“Future-proof” is a phrase we use frequently in healthcare design, but I prefer future-flexible.

Future-proof implies that we can build an environment today that is somehow protected against whatever happens next.

We cannot.

Future-flexible means something different: designing an environment that can adapt as technologies, programs, budgets and expectations change. Technology continues to evolve, and so should your facilities.

That does not mean filling walls and ceilings with infrastructure for every imaginable future scenario, or implementing costly technologies for their own sake.

The discipline is deciding where flexibility creates true value and protects capital investments for decades.

In some spaces, that may mean installing the pathway, power or rough-in for something the organization knows it wants eventually but is not ready to deploy at opening. In others, it may mean creating enough backbone capacity, wireless coverage or equipment-room space to support future growth without overbuilding the project today.

There is a concept borrowed from lean thinking and software development called the last responsible moment. The idea is simple: make a decision when you need to, not just because you can. Every decision made too early risks closing doors that could have remained open.

Think of driving from New York to California. You don’t need to know every turn before you leave. You need to know you’re heading west. As you get closer to your destination, you can make increasingly informed decisions about the best route forward.

Technology planning can work the same way.

Define the destination early. Build the infrastructure that keeps the right routes available. Make the decisions that matter when they need to matter.

That means committing early to the infrastructure, capacity, and integration requirements that shape the building, while allowing specific product and vendor decisions to mature as the project approaches opening.

The result is a facility designed for tomorrow without being locked into yesterday's technology.

Treat technology as a design input, not a drawing package

Technology is still too often treated as a collection of outlets, conduits, cables and specifications.

Those things matter. But they represent only part of the widening technology environment.

Healthcare technology is an interconnected ecosystem.

Systems communicate with other systems. Devices interact with building infrastructure. Patient-room technologies connect with lighting, shades, HVAC, nurse call and entertainment. Mobile devices, wearables and technologies outside the physical footprint of the hospital increasingly become part of the experience as well.

And seemingly small decisions can create very physical consequences.

A more technology-dense floor may require larger equipment rooms and greater backbone capacity.

A large digital display may create electrical and cooling requirements that must be coordinated with the design team.

Two independently selected systems may rely on proprietary protocols that don’t integrate cleanly—or on incompatible standards—if no one is looking across the entire technology ecosystem early enough.

Those are not simply technology problems. They are design, operations, infrastructure and capital-project problems, and they are much easier to address before systems are selected and installed.

The earlier technology is part of those conversations, the more options the project team has to solve them intentionally.

Set the vision early—and keep coming back to it

Early involvement does not mean making every decision early.

In fact, good technology planning should allow some decisions to remain open longer.

The first step is establishing a clear vision: what should this environment be capable of doing?

Then revisit that vision throughout design.

Is the program still headed in the same direction?

Have workflows changed?

Has a new technology emerged?

Are assumptions made during schematic design still valid during design development?

Does the infrastructure still support the experience the organization is trying to create?

A five- or six-year capital project is too long to set a technology strategy once and never look at it again.

The approach should be early and often: establish the direction early enough to influence the building, then continue testing it as both the project and the technology landscape evolve.

Prepare for what you cannot predict

I cannot tell you exactly what technology a facility you’re designing today will rely on in 2040.

No one can.

But we can understand the capabilities and experiences the organization wants to create. We can anticipate the infrastructure those capabilities are likely to require. We can ensure systems are designed to connect rather than operate in isolation. And we can preserve enough flexibility for the building to adopt technologies that have not yet reached the market.

The objective is not to predict what comes next.

It is to make sure that when what’s next arrives, the building is ready to accommodate it.

You can’t predict what’s next. You can prepare for it.