Leonard Berry

No building is more important to design the right way the first time than a hospital. Hospitalised patients, under extreme stress, are vulnerable to poor design that can raise the risk of negative outcomes. Poor design can contribute to staff fatigue, medical errors, injuries, inefficiencies and low morale; it also undermines the goals of the health system that pays for the building, given that hospitals are in use for many years once they are built. Financial shortcuts in designing and constructing a new hospital or renovating an existing one offer a false economy.

Healthcare is a service like no other. People’s quality of life—and life itself—are at stake. Medical centres need to be built with intelligence and soul. They are among a community’s most important assets. They can be anchoring institutions in times of pandemics, environmental and other disasters. Hospital leaders have a responsibility to use the best available evidence to create a structure that serves well the people who use it, that is a beacon of hope in the community and that is as high performing, safe and environmentally efficient to operate as possible. We propose a model for building such hospitals; we hope that the analysis and examples will inspire the will to do so.

In 2004, a multidisciplinary team decided to refute the myth that building better hospitals was unaffordable. They asserted that paying more up front to build a hospital optimally based on strong evidence quickly returned the additional investment by improving efficiency, safety and quality. They showed that a modest increase in initial capital construction costs (first costs) could reduce multiyear operating costs (life-cycle costs), resulting in a compelling business case. They called it the Fable Hospital, a 300-bed fictional hospital in average Anywhere, USA, used to test the business case ideas.

In 2011, the team updated the analysis—Fable Hospital 2.0—incorporating newer design evidence published since 2004 and current construction cost estimates. Fable 2.0’s long-term business case was even stronger due to reductions in hospital-acquired infections, patient falls, lengths of stay (LoS), hospital room transfers, workforce lift injuries and energy and water use. This article introduces Fable Hospital 3.0, which builds on the spirit of the earlier lessons and includes the latest research in new categories of impact. Fable 3.0 also delves more deeply into proven and innovative sustainable design solutions in response to the climate crisis.

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This study explores how epiphanic experiences – sudden, identity-shifting insights – catalyze service leaders’ adoption of a Social Profit Orientation (SPO), defined as a commitment to advancing financial, social and environmental goals simultaneously. By examining the psychological and contextual origins of such moments, the paper illuminates the human dimension behind purpose-driven organizational transformation.

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The mission statement of most healthcare organisations articulates the duty to care. By committing to serve, heal, help and improve the health and lives of patients, organisations acknowledge their role in the community and set expectations for their actions.

As healthcare institutions worldwide navigate increasing costs, workforce shortages, ageing populations, rising chronic-disease burdens and other big challenges, the need to align decision-making with the mission grows in importance and complexity. The boards that govern these institutions play a major role in anticipating, evaluating and responding to those challenges. Although the context, structure and regulations may differ from nation to nation, we assert that healthcare boards have a responsibility to protect and improve patient care as a central purpose of their activities.

In this article, we draw from our collective international experience serving on more than 10 healthcare and corporate boards of directors, and from the available evidence to analyse how healthcare boards could more effectively lead their organisations’ efforts to make care their core mission.

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