The hospital of the future: the vision, the journey, the reality.

Palomar Medical Center, like many California healthcare institutions in the 1990s, faced the challenge of needing to meet state building seismic requirements. As a result of the mandate and infrastructure demands that would need to be made to accommodate the new standards, the health system set out to assess the larger needs of the communities served, evaluate the medical and technological changes that would be part of future clinical care delivery systems, and assess our capability to meet the financial impact such changes would have on the organization. This article shares our journey to build a new hospital--one that could be studied by other health systems facing the same or similar challenges. It incorporates elements associated with the concept of "Fable Hospital"--a design promulgated by leading architects and designers from around the world and researched by the Center for Health Design--which considers the use of evidenced-based principles gathered over the past 20 years that, when incorporated, can lead to the creation of buildings that enhance the quality of care, provide safety for patients and staff, and meet the needs of patients and families in meaningful ways. Finally, Palomar Medical Center is an environment that allows for effective, flexible integration of technology and expansion of staff while improving the efficiency of operations that are critical to the management of the hospital in a changing healthcare delivery world.