Inside Healthcare - RedCoat Publishing

Joseph Balbona started designing hospitals 40 years ago when, he said, private patient rooms were ahead of the curve for the first time. As one of the second generation of principals for this 55-year-old firm, he attributes the firm's success not only to experience but to doing things right the first time.

"Healthcare has changed over the years, but mostly just by getting more and more expensive," he said, citing reports that costs have risen by as much as 20% each year. "For us, nothing has changed: we design hospitals to operate as efficiently as possible to provide the highest of quality care for patients."

Established in 1952, RBB Architects provides programming, planning, and design services for all kinds of healthcare facilities-it's the preferred provider for Catholic Healthcare West, St. John's Health System, and Providence Health System to name a few-as well as other complex institutional facilities such as university research and clinical testing labs. Its education experience includes projects at five University of California campuses, multiple California State University campuses, University of Southern California, and Boise State University, among others.

The firm has successfully completed more than 10,000 projects, mostly in the Western US but also across the country and around the world in Israel, Jakarta, Central America, and Asia. Balbona said the firm doesn't go looking for business abroad but is especially open to the idea of expanding in this economy.

"We typically design more than $300 million in construction annually. Luckily, we have a sufficient backlog of projects to get us through 2010, but the market is extremely competitive right now, and I wouldn't say no to a project," he said. He added that the firm is working to expand its penetration in the education market with student housing projects and is competing for federal work at VA and Navy hospital projects nationwide.

In the meantime, RBB architects is keeping busy with a pro bono hospital design in Ethiopia; Balbona said, as a firm, they are always looking to do the right thing.

That's why four years ago when the LEED organization began offering individual accreditation, all RBB's principals and many of its design employees signed up. Even though most of the firm's clients are not interested in having their buildings LEED certified, its architects specify environmentally friendly practices and products whenever possible. He cited examples, like high-performance glaze for the outside of buildings, which he said quickly pays for itself in energy costs and the development of draught-resistant landscaping that is cheaper to maintain.

"And we always specify only recycled or recyclable products to be used in the construction of our buildings. We use the LEED requirements as a baseline whether the client wants to pay for certification or not," Balbona said.

The principles of design
The catch is, of course, keeping costs low without sacrificing quality care. For efficient hospitals and other healthcare facilities as for sustainability standards, RBB architects have developed creative ways to save money without cutting corners.

"The average hospital costs between $600 and $1,000 per square foot and requires roughly 2,000 square feet per bed. At RBB, we've adopted the lean philosophy from the manufacturing and construction industries for design and aim to have no redundant space and the most fluid circulation possible," Balbona explained.

The firm's most recent completed project, a 189-bed hospital, required only 1,500 square feet per bed and cost $165 million; Balbona said the firm saved the hospital nearly $50 million by developing an operationally efficient master plan and organizing the hospital more effectively.

He said there are a few key principles to follow to do so. One is minimizing a hospital's payroll by making it easy for fewer employees to accomplish more in less time; according to him, the annual payroll for three years of work equals the initial cost of construction, and most hospitals last for 50 or more years.

The second is making the most of the site. "From the beginning, you need to design the site with one, two, or three incremental expansions in mind and not box yourself in," Balbona explained. "The circulation of people through a hospital is the most obvious reason, but parking is good example: they say a hospital needs two parking spaces per bed, but from experience, I know it's more like five. And each space costs as much as $30,000, so you need to plan accordingly for the future.”

The third and most important one is designing the hospital around the need of the patients and the families. That of course means private rooms but also space for the family to be, mediate, or pray, as well as distractions in the form or art or landscaping. Balbona said traditionally, RBB has never paid much attention to marketing strategies because its designs speak for themselves.

"When the patients and families are happy, the hospital is successful. When the hospital is successful, it comes back to us again for new projects. Because we are always thinking about the most efficient way to deliver effective and high-quality care to patients, we have a rate of repeat business close to 90%," Balbona said.

Not to mention a long list of awards, including a ranking as one of the top 500 A/E design firms in the US, top 25 in healthcare nationally, and top 25 firms in Southern California. RBB also has consistently earned AIA Design Awards each year for over the last decade.

"Times may be tough now, but we're in a strong position for when the market turns," concluded Balbona.

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