The goal of the American College of Healthcare Architects (ACHA or "the College") is to transform health care through better built environments. To that end, ACHA provides board certification to architects in the United States and Canada who specialize in health care. The certification process is rigorous and overseen by an independent testing agency, in order to establish a professionally sound, legally defensible standard by which people can identify themselves as health care architects.
The tagline of the College is Experienced, Certified, Preferred, but what does that mean and how it that relevant to the C-Suite, the industry, and most importantly, the patients?
The College is comprised of certified healthcare architects with a deep knowledge of design and the impact on the healthcare community. According to a survey of its certificants in 2014, the College found:
- ACHA certified architects have 28.7 years of healthcare design experience.
- Nearly 90% of all ACHA certified architects focus primarily on healthcare design.
- ACHA certified architects have published an article or a book on a healthcare topic an average of 4.5 times.
- ACHA certified architects have presented a topic at a healthcare conference or similar event an average of 8.7 times.
The first step in certification is having that experience reviewed by an independent body of peers who carefully examine the portfolio submitted by a candidate. Once the level of required experience is confirmed, the candidate is approved to sit for the examination.
To preserve the integrity of the testing process, it continues to be overseen by an independent, third-party testing company. Questions are developed by the ACHA exam committee, which is chaired by an ACHA certified architect and appointed by the College's board of regents. These questions are reviewed for clarity and properly framed with input from the testing firm. This process ensures questions cover the needed material, are not ambiguously worded and conform to scientifically appropriate models for examining candidates. Because test takers must be licensed architects, the exam is geared towards topics related specifically to health care projects, as opposed to architectural domains already covered by architectural licensure organizations. Unlike many other certifications, the ACHA examination is based on experience and much of the content cannot be studied.
The certification exam is divided into four major sections with questions falling into the categories of analysis, application and recall. The first section covers the forces that drive the business of health care, including economics, regulation and reimbursement, health care models and technology. The second section is about pre-design, with questions regarding programming and master planning. The third section, on design, has questions about facility design, departmental design and detailed design, like coordinating equipment layouts, requirements and manufacturer specifications or developing room data to align with patient and staff safety, experience and privacy needs. The final section covers delivery and implementation, with questions about contracts; construction documents; reviewing owner-provided fixed medical equipment and technologies for coordination with contract documents; assisting the owner with approval, licensing and certificate of occupancy processes; and post-occupancy evaluation and research. Each item on the test is linked to a specific health care setting: general, acute care, post-acute care, outpatient care or behavioral and mental health care.
The entire certification process is designed to recognize the expertise of architects who have substantial experience in all aspects of health care architecture projects. Architects who earn the ACHA credential have had their health care experience and knowledge independently evaluated and approved through the application, portfolio and testing process. It's a stamp of approval that differentiates architects with specialized health care skills for their clients, employers and colleagues.
While there are many highly qualified and experienced healthcare architects in the industry, some discerning industry leaders are more comfortable going with an ACHA architect who has been through the rigorous certification process. The College encourages professionals with this specialty to do the same, whether emerging professionals or icons in the field.
Message from the President
Years ago when I was teaching architecture students in The Health Environments Institute at the University of Houston about healthcare facilities and the vagaries of the healthcare marketplace, I would bring to my class a guest lecturer on ethics: Stanley J. Reiser, MD, PhD. Stan became a perennial guest in my classroom. Not only was he a brilliant scholar, but one of the most entertaining individuals I have ever known. His wit, piercing insights, and provocative Socratic repartee combined to position him in any conversation (or classroom) as the center of attention, whose pause even to take a deep breath before continuing left everyone momentarily concerned that the magic might be nearing an end.
And he made my students really think.
Stan made ethics relevant to architecture students in a way that never failed to grab my attention, no matter how many times I watched him do it. First, he would challenge each student to give a definition of being ethical as a professional, and one by one they would each give a description of ethical behavior. Eventually, after an appropriate amount of discussion, he would reframe the question with a story line.
“Why,” he would ask, “would you go into a small room, disrobe, disclose personal health and behavioral secrets that nobody else knows to someone you might see only once each year, and then allow that person to touch you in places nobody else is allowed to touch? After that experience, why would you ask advice on how to protect your most valuable asset and discuss when you might come back and do the whole routine again?”
Stan wanted the students to recognize the role of ethics in the annual encounter between a patient and a physician. Ultimately he explained that ethical behavior of the physician was what allowed the patient to be so trusting of another human being in an otherwise vulnerable situation. More specifically, he went on to say that as a result of the physician’s ethical behavior:
The patient behaves that way because he/ she trusts the physician to act in his/ her best interest.
How simple. How elegantly simple, and yet so profound. My students were always visibly touched by the clarity of the message, and even I, 30 years hence, have not ceased to consider the implications of ethical behavior for professionals of all kinds.
Can we in the College be any different?
At the PDC conference in March, 2017 we heard Jamie Orlikoff revisit his message from earlier PDC events when he reminded us of the “tipping point” phenomenon in world economies .He has, with exceptional clarity, powerful scholarship, and the passion of an evangelist, proclaimed the reality that the United States economy is moving dangerously close to its own tipping point. That is the point when one segment in the economy, measured as a percentage of the Gross Domestic Product, becomes so large that it throws the entire economy out of balance – with potentially disastrous consequences. The healthcare market segment is continuing to grow as a percentage of the GDP, with no indication that the growth is easing, to a level ominously close to the predicted tipping point for the United States economy.
Only this year he went one step further. He explained that one of the markers of the imminence of this phenomenon was the erosion of the middle class in our population. His example of an indication that this was beginning to happen was the inability of the producers of a good no longer being able to afford that good – in his example, the producers of healthcare.
Dan Mangan1 wrote for CNBC that in the United States health deductibles for 2016 rose 12% in one year to $1478.And Chris Lange2 wrote for wallst.com that nearly 60% of Americans do not have $1,000 for a surprise emergency room visit. It seems that the payment for care has now exceeded the ability of the producers to pay for it.
According to Jamie Orlikoff, this suggests that the American middle class is eroding. And so the tipping begins.
The challenge that must ultimately come before us for consideration is balancing the priorities of our business with the greater good for the country. We certificants have a seat at the table where healthcare costs continue to rise. We have a voice in the conversation that debates alternate paths forward in healthcare and invites cost-reducing creativity with unrivaled urgency. What will we say? Will anyone in a future generation accuse us of rearranging the chairs on the deck of a sinking ship, while ignoring the potentially ship-saving interventions that might have averted disaster?
We must be driven, above all other personal, professional and societal motivations, to be ethical and behave in a way that tells others they can trust us to act in their best interest – not just for their health system, or for the healthcare market sector, but for the United States economy as a whole.
1 Dan Mangan, Workers’ health insurance premiums rise modestly, but deductibles jump a lot more, CNBC, Sep. 14, 2016.2 Chris Lange, Most Americans Can’t Afford Common Unexpected Expenses, 24/7wallst.com, Jan. 12, 2017
A. Ray Pentecost III, DrPH, FAIA, FACHA
President, American College of Healthcare Architects, 2017
Become a Certified Healthcare Architect
We appreciate your interest in the American College of Healthcare Architects. If you, or someone you know is qualified, the Regents invite submission of an application. Learn about the ACHA application process.