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Hospital Chief Executives and their boards, helped (aided and abetted) by their architects, have constructed some impressive hospitals and support facilities, even attention to the small details is impressive like kitting out their staff with promotional healthcare clothing. From humble community hospitals in small towns across America, to the big box medical centers in the regional centers of commerce, more often than not, the image of the hospital is defined by the quality (size) of the building, the technology inside and its medical staff.

Changes in the way healthcare is delivered, both from the Patient Protection and Affordable Care Act (PPACA) and also some rather draconian deficit reduction measures will most assuredly affect Medicare spending. This could force us to stop looking at buildings as the center of our healthcare delivery universe and to begin to think about population groups and geographical territories.

Buildings will always be central to healthcare delivery. But instead of focusing on brick and mortar for how and where we should deliver care, CEOs and their employees should shift their focus to their customers, their markets and geographic territory. This shift, a nuanced course correction in the eyes of some, will become, over time, a central article of faith in terms of how we design our system and allocate resources. And over time, this rather radical transformation will play a significant role in reducing healthcare costs.

In the end, however, no one initiative will solve our massive and growing healthcare spending challenge. There are literally hundreds, if not thousands, of transformative changes and tweaks that will have to occur, from the role of EMS in pre-hospital care, to treatment protocols and locale.

These will be challenging, but exciting times. Fortunately, we are an industry that has attracted some of the top graduate school talent over the past 10 years.

I am looking forward to this transformation a great deal.

2012 John Gregory Self