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Why are best practices so elusive in Behavioral Healthcare?

September 2, 2014
by Kevin Turner
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I recently received a Request for Proposal for a new behavioral healthcare project. Along with the usual questions, this one contained a seemingly simple question: “Tell us what the current trends and best practices are in behavioral healthcare.”

No problem, right? If we received that question related to a bed tower or a surgical suite, we would have the answer readily available. Acute care settings have best practices pretty well defined. Sure there are preference issues like same handed vs. opposite handed rooms and centralized vs. decentralized nurses’ stations, but the experts pretty much agree. Why is behavioral healthcare so different?

Before you try to answer that, let me assure you that everyone I meet in the field is very sure they know what best practices are. I have had lots of conversations with practitioners in which they explain in great detail why the facility should function a certain way and even assure me that everyone does it that way and there just isn’t any debate on said issue. I file that tip away in my memory as a “must do” until I go to another facility and suggest the same approach. My new tip is usually met with a snort and “what idiot would do it that way? I thought you were an expert at this.” I have even run across this situation within the same system!

As a designer, I am trained to look at the big picture, so when I see such variation, I wonder what it tells us about the wider industry. It may be a significant problem that so many facilities work so differently. It may mean that there are significantly different levels of care. It may be a symptom of widely varying responses to a seemingly irrational payment system.

But what if it is a good thing? What if it means that experimentation is happening. With so many different approaches being implemented throughout the industry, surely some will be found to work better. Variety is the fertile ground where innovation is possible. Perhaps that variety is a good thing.

I hope that people in the industry are watching all the variety. I hope you are talking to each other and comparing metrics to determine which approaches have better outcomes. When you find out, please tell the architects. We would really like to know. In the meantime, you may be wondering how I answered the question about best practices. I told them the one thing that is certain: behavioral health facilities should be designed to be flexible and adaptable. Because who knows what is coming next.


Kevin Turner

Principal, Perkins+Will

Kevin Turner

Kevin is a recognized leader in the design and operations of behavioral healthcare facilities. ...

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