Is less really more? Or can only more be more? This aphorism, “Less is More”, surfaced in the 1855
poem Andrea del Sarto by Robert Browning, but was later attributed to Ludwig Mies van der Rohe, a German/American architect of the modern era, as his motto due to repeated use by him and his followers. He used this simple concept as a way of expressing the spirit of twentieth-century architectural style and adopted it as a precept for minimalist design, or in layman’s terms, “keep it simple”.
How does this “less is more” concept apply to healthcare in the twenty-first century? From an architectural and facility perspective, “less is more” describes where the hospital of the future is going, or has been going for the last 10 years. Many of us just didn’t notice this evolution. Driven by changes in insurance reimbursement, escalating healthcare costs, fierce competition for the healthcare dollar and the wants and desires of the healthcare consumer, the hospital facility is shrinking and outpatient locations and homecare offerings are growing. The winner in this race is going to be the healthcare systems that downsize their hospital-based facilities and grow their outpatient and homecare facilities as quickly as possible. The large hospital building that housed all services in one location used to be thought of as an asset, but now, in these changing times, it has become a liability.
Hospital construction is one of the most expensive square footages to build, maintain, heat, cool and constantly meet the highest level of regulations and scrutiny by authorities having jurisdiction. The new model of healthcare delivery will reduce the size of a hospital to its smallest possible functional size to house the 24-hours-a-day critical care and inpatient care components only. All other outpatient care, administrative and support services will be housed elsewhere in construction that is less costly to build, maintain, heat, cool and has much less stringent regulations to meet. And, these non-hospital facilities will be located closer to healthcare consumers’ homes, which will increase patient satisfaction. Sounds like a win-win situation for everyone involved.
A smaller hospital, with less square footage to heat, cool, clean, supply, staff, secure, light and maintain 24-hours-a-day, 365 days a year, every year, will save many dollars and FTEs. The hospital’s chief financial officer will be smiling from ear to ear. But to realize these savings, there are only two ways to achieve this size reduction. The first option is to build a newer, smaller, more efficient and flexible hospital and abandon the old facility. The second is to consolidate services into existing areas that are the newest and most efficient and tear down the inefficient and more costly wings. Simply closing or abandoning some of the existing space is not a solution. “Less is more” in this case means having space that is only in use generating income and eliminating the rest.
Allowing the hospital facility and campus to be smaller and more compact provides a number of benefits including: less parking required, improved circulation simplicity and clarity, lower energy and maintenance costs, reduced distances between departments and services, fewer staff members required to run the facility and the option to have windows in most spaces to promote healing. By reducing the 24- hours-a-day portion of the healthcare system to the minimum square footage and increasing the 8am -5pm portion to the maximum, major cost savings should be realized. This is a 180º turnabout in the healthcare delivery model after spending the last 50-100 years making hospitals bigger so that they can be everything to every person in one location. This new model may now result in a hospital that is only about 25% of a health system’s area and the other 75% is non-hospital space for outpatient services, administration and support.
The “Lean Design and Operation” concept that has been adopted by many hospitals nationwide in the last 5-10 years has had the goal of trying to reduce healthcare costs, improve efficiency, shorten steps for staff members, improve patient and staff safety and make facilities more user-friendly. Many institutions have been pleased with their efforts and results to make their facilities and processes leaner and more efficient. But, like most good things, “Lean” is not a new concept, it is just a validation that “Less is More.”
Scott Hazlett is a Senior Architect and Medical Designer at DRS Architects in Pittsburgh, PA. As one of Pennsylvania’s leading architectural, planning and interior design firms, DRS Architects has experience and expertise in a wide variety of healthcare specialties. We pursue quality, technology and innovation in creating facilities that enhance the designed and natural environment. Scott can be reached at [email protected].
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