The topic of healthcare reform has been in the news a bit lately, and during this rough economy, healthcare has been one of the few sectors that has continued to show robust enough activity. In fact, healthcare facilities reform has been underway in the A&D community for quite some time now, as evidence-based design trends continue to drive healthcare facilities that wish to remain competitive to improve their interior environments for more positive patient outcomes. But as the jurors of this year's Healthcare Environment Awards (see "To Your Health," p. 62) point out, this sector has not been completely immune to economic woes either, making future progress in this area a bit uncertain—at least in the short term.

Thanks to Bill Rostenberg of Anshen+Allen for this month's Green column on the design challenges that exist at the intersection of evidence-based design and eco-effective design (see "Two Roads Diverge," p. 36). For those of you who thought, as I have, that the reason the healthcare sector seems to lag behind others in implementing sustainable building practices mainly has to do with the many, onerous building codes that influence (some would say limit) the design of hospitals and other healthcare facilities, Rostenberg's essay raises another possibility that the principles of evidence-based healthcare design actually conflict on some levels with the principles of sustainable design, presenting design teams and their clients with some difficult and potentially frustrating choices. For example, sustainable design embraces a less-is-more philosophy that encourages smaller building footprints. On the other hand, many hospitals today are developing highly successful, evidence-based models embracing larger and all-private patient rooms, which necessarily increase a building's footprint.

I heard recently that compromise resulting in one party feeling like they have won and one party feeling like they have lost rarely yields positive results. Instead, a more successful compromise is a lose/lose situation, where each party feels okay about having given up something, for the benefit of the whole. This may be true, but I'd like to think that in design, there is also the possibility of a win/win situation, where the best features of each approach ultimately inform a better outcome, so that evidence-based design principles do not necessarily have to be sacrificed for green design principles in healthcare facilities, and vice versa. As proof, the LEED Gold certified AtlantiCare Cancer Care Institute, designed by EwingCole and featured in this issue (see "Healthy Building," p. 46) seems to have gotten things right. As Rostenberg points out, more and more, designers are going to have to think carefully about the synergies—rather than the conflicts—presented by these two prevailing design trends.

This month's issue offers some compelling reasons to keep the focus on design as an essential part of reforming a broken system, with essays, observations, and projects by experts from many of the best healthcare design firms practicing today, including SmithGroup, NBBJ, Anshen+Allen, EwingCole, and Howell Rusk Dodson. And the beauty of the Web is that the conversation is continued and expanded online at, with more from Perkins+Will, Tsoi Kobus, Francis Cauffman, and Ellerbe Becket. All in all, it's a healthy dose of information on the current—and future—state of healthcare design.