on the question of why
At a recent conference held in Toronto last November, I shared how my work has evolved in a post-COVID reality. We can’t deliver tomorrow’s care using yesterday’s infrastructure or yesterday’s decision patterns.
Our new reality is that everyone’s time is our most expensive commodity on any given project. We need to align everyone on the question of “why”—the essential questions that define purpose, priorities, and constraints, all of which govern the subsequent actions.
When we synchronize our questions (i.e., our “whys”) early on, the process of defining a healthcare facility’s architecture evolves from practical, strategic advice, rather than working from a posture of reactive problem-solving.
That’s what helps organizations run better healthcare facilities, not to mention ensuring their readiness for the next pandemic.
macleamy curve
In my work, I often refer to the MacLeamy curve, a simple yet powerful idea developed by architect Patrick MacLeamy: the earlier you can make decisions on a project, the cheaper and more effective the changes will be later in the design process. In healthcare, this effect is amplified because decisions cascade across infection control, patient safety, staffing, equipment, and phasing in 24/7 environments. Emphasizing the pre-design work at the beginning saves the overall time needed to realize a project, thereby lowering the risk of late changes, protecting budgets, and reducing fee erosion for design teams.
Other sectors have already adopted this habit in various ways, including Integrated Project Delivery (IPD) and Lean pull-planning (a scheduling technique that starts with an end goal and works backward to identify the steps needed to get there. BIM’s early coordination, Passive House’s performance modelling, and software developers’ “shift-left testing” are all versions of the same truth—invest up front to save downstream. As architects, Clover translates that methodology into our own approach to healthcare pre-design: a time-boxed, decision-oriented process that earns faster signoffs and fewer change orders for our clients.
THE CLOVER APPROACH
In traditional project delivery, pre-design is often misunderstood as an “additional service,” while fees are disproportionately weighted toward construction documentation and administration (CDs and CA). That structure can unintentionally starve the upfront phase that dramatically safeguards precious project funds. When the “why,” scope, and clinical workflows aren’t fully resolved before schematic design, you inevitably push uncertainty forward and pay for it later through change orders, delays, and stakeholder fatigue.
Clover’s approach to mitigating negative impacts on a project’s success is straightforward: treat pre-design as an essential scope and allocate the necessary time and resources to ensure its success.
If medicine teaches anything, it’s that prevention beats cure. The same holds for capital projects: the earlier we test, diagnose, and treat, the better the outcome. Clover’s role is both mediator and translator. That’s how we “shift left” together: fewer change orders, faster sign-offs, more substantial budgets, and spaces that can flex when the next crisis arrives.
If you’re a hospital leader or partner who wants decisions made earlier, with less friction and more confidence, let’s talk about running the maypole on your next project.
The Clover Approach