Bricks and Clicks

Pay attention to hospital construction as well as IT

By Ian Morrison

Bricks and Clicks was a popular phrase back in the New Economy of 2000 that was used to describe the integration of web-based information technology (clicks) with physical buildings and real estate infrastructure (bricks). The argument was that successful enterprises would have to thoughtfully deploy physical and IT assets to serve customers more effectively and to improve organizational performance.

In health care, we are spending a lot of time, money and attention on the clicks part. We have a National Healthcare Information Technology czar in Dr. David Brailer, as we should. He is galvanizing the field to lead us toward implementation of an interoperable, national healthcare information infrastructure.

Achieving a workable National Health Information Network in five years would require $156 billion in capital investment and $48 billion in annual operating costs, according to estimates by an expert panel published in the Aug. 2 Annals of Internal Medicine. That includes an estimated $50.7 billion in capital and $12.8 billion in operating costs for hospitals over 5 years, or approximately $10 billion per annum capital investment in hospital IT. Remember this is a goal not a fact.

Ironically, hospitals are anticipated to actually spend $15-20 billion per annum in capital investment for new construction over the next decade (almost twice the run rate of the estimated goal for IT). In a recent unpublished Harris Interactive poll, 86% of hospital executives anticipated making significant investments in hospital IT over the next 2-5 years, but an equally impressive 85% anticipated initiating new construction projects. We are obsessing about the clicks and forgetting about the bricks.

I recently joined the board of the Center for Health Design an impressive group that has brought together prominent healthcare architects, designers, researchers, academics, healthcare experts and hospital CEOs on its board to help advance the field of evidence-based design for healthcare facilities. The goal of the Center is to promote safer, more effective, more beautiful and more healing hospitals and facilities, by applying research evidence primarily through a network of more than 30 Pebble partners (as in pebbles creating a ripple effect) of hospitals actively involved in building new facilities. My fellow columnist Joe Flower did a wonderful job reviewing the findings of a recent research report done for the Robert Wood Johnson Foundation by Roger Ulrich and Craig Zimring (also members of the Center’s Board) so I won’t repeat it here, suffice it to say that there is good science to support the conclusions that single patient rooms, proper location of hand washing facilities, greater attention to issues like light and noise, make substantial differences in the outcomes for staff and patients alike. (The entire Ulrich/Zimring report can be downloaded from the Center’s website at

We need to pay as much attention to the built environment (the bricks) as we are to the IT infrastructure (the clicks). Organizations like the Center for Health Design and its partners and projects are making a major contribution to advancing the state of knowledge and the quality of hospital construction that results. But the entire health field and hospital CEOs in particular, need to focus on the investments we are making in both IT and buildings. The goals are the same: to reduce errors, make patients safer, improve clinical processes, reduce waste and waiting, make patients healthier faster, in an environment that is humane and pleasant for patient and staff alike. And, by the way, perhaps the biggest pay-off of good design and good IT systems may be in improving the life of the nurse.

My plea is that we think about these two massive areas of investment as equally important, complementary, and deeply connected. They are two critical building blocks (pardon the pun) in the required transformation of health care delivery. My only concern is that both construction and IT are hugely expensive when done right. Where is the 50% price point breakthrough that Charles Schwab delivered in financial services largely through a bricks and clicks strategy? If we could do this right and save money that would be fantastic, as yet I don’t see it. Healthcare delivery is going to be much better because of bricks and clicks, but it’s not going to be cheaper.

Ian Morrison is an author, consultant and futurist based in Menlo Park, California.