using fuel cells. Currently, fuel cells are not economical; however, this could change if the money spent on disposing of waste was spent instead on treating waste as energy in a different form. Waste can become heat and power, and can produce commercially viable and ecologically sound products (mostly carborundums and additives to concrete and asphalt) that are never burned in their life cycle, stated Parker.

Detailed Cost and Savings Estimates for the Fable Hospital

Fable Hospital has private patient rooms that are 100 square feet larger than typical hospital rooms. At a cost of $185 a square foot, the larger rooms increase construction costs by $4.7 million. Overall, the construction cost premium for Fable Hospital is $12 million, or 5 percent of the construction budget, said Parker. A hospital chief executive officer would require evidence of benefits before approving such additional expenditures.

Reduction of patient falls is one of the benefits found by the Pebble Project. When patients (especially elderly patients) fall, they risk fractures and complications, such as pneumonia, that result in longer hospital stays. According to Parker, the average cost of an unlitigated fall in the United States is $10,000. A Pebble Project study found that an 80 percent reduction in patient falls can be achieved by installing double doors in bathrooms and moving telephone cords and nursecall cords out of the way (Hendrich et al., 1995).

Based on the Pebble Project results, Parker suggests that better design may result not only in fewer patient falls, but also in fewer patient transfers, fewer nosocomial infections, reduced nurse turnover, and reduced drug costs. Based on these savings, the initial investment of $4.7 million would be recovered in a few years (Table 4-1). Parker further asserted that increasing market share and philanthropy would add to the hospital’s revenues, thus justifying the construction premium (Table 4-2). Cost avoidance savings alone, if invested at 3 percent for 30 years, would pay the capital costs of the hospital many times over.

According to Leonard Berry’s book Discovering the Soul of Service, leading

TABLE 4-1 One-Year Savings on the Fable Hospital

Fewer patient falls


$2,452,800 (–80%)

Fewer patient transfers


$3,893,200 (–80%)

Fewer nosocomial infections


$80,640 (–4/m)

Reduced nurse turnover


$164,000 (14–10%)

Reduced drug cost


$1,216,666 (–5%)


Total cost savings


SOURCE: Berry et al. (2004). Reprinted with permission from The Center for Health Design.

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