While we were finishing up this issue of the magazine, Jonathan Perlin, M.D., the chair of the American Hospital Association’s board of trustees, and president of clinical services and chief medical officer of HCA, visited our Chicago office for the annual meet-the-chair event. It’s an opportunity for staff to learn about the new chair’s background, professional experience and goals for his or her yearlong tenure, and we were impressed that Perlin was still willing to visit on the coldest February day in 79 years.

Most of his remarks focused on access to care. Not surprisingly, the former U.S. Department of Veterans Affairs undersecretary for health, who recently spent a few months assisting in the system’s turnaround, is particularly passionate about improving access for all. "Being healthy is part of the American dream, ethos and psyche,” he says. “Without access, there is no health, and without health, there is no opportunity.” But threats to access persist, even among insured patients, and millions remain uninsured. Trustees' advocacy on behalf of their hospitals and communities can make a real difference.

The term “access” has more than one meaning in health care. Perlin’s remarks brought to mind this month’s feature on redefining the care environment [Page 13]. The three institutions we profile are using design and construction to achieve efficiency and quality goals, but they all include elements that facilitate easier access to their services. Whether it's designing a campus that’s more open to its neighborhood, grouping frequently used services near an entrance or combining outpatient services in a single building, these organizations are using new ways to make the path to better health shorter and more welcoming. We haven’t covered construction in the magazine for several years, and we hope you find the story and photographs inspiring.