By Scott Hazlett, AIA, ACHA, EDAC
Healthcare delivery has been changing rapidly over the last 10 years in our local region and across the country. The traditional healthcare points of delivery that included the community hospital, the hospital owned outpatient clinic and the physician-owned doctor’s office are quickly fading into the past as the healthcare model evolves.
What is the healthcare facility model in 2014 and the future? What is driving this rapid change that is altering the healthcare delivery model that we have known most of our lives? There are no simple answers to these questions because of the many influences creating these changes: healthcare insurance and changes in reimbursement; mergers and acquisitions; facilities that look like luxury hotels; healthcare campuses that look more like a college campus; healthcare available at your local Walmart or Walgreen’s for convenience; high-end rehabilitation facilities that are close to home; retirement communities that offer many levels of care including independent living, assisted living, nursing home care and hospice care all in one place; home healthcare that comes to you; and home monitoring that allows you dial in and download for medical care in your own home. This list could go on and on, but you get the idea.
It is not that the physicians and hospital administrators want to have a base hospital and dozens of satellite locations to maintain and travel between; it is the insurance companies that want to reduce costs and the healthcare consumer who wants convenient outpatient or at-home services that are driving these changes. Hospitals and healthcare systems are required to meet these needs because competition for every healthcare dollar is fierce and they need to find strategic advantages in order to secure these dollars. Whether it is two large regional health systems or two community hospitals in neighboring towns, they are all chasing the same healthcare dollars.
For a majority of the last 50-100 years, hospitals have been challenging architects and engineers to continue adding space to hospitals with new additions, air rights expansions over existing buildings and even adding subterranean spaces below existing buildings, parking garages and plazas to accommodate their need for space to house new procedures, new equipment and larger patient through put capacity. The hospital in most communities was always considered a permanent anchor in the context of a great community. It was thought to be too big and too costly to ever move or replace, so renovations, additions and updates were the only logical course of action. Unfortunately, the result was a mega-block of a building that had a lot of contiguous clinical space, no windows, a maze of hallways and the highest cost-per-square foot to build, renovate and maintain than any other place designed for use by people. Lost were the cues given by natural light and views from windows, internal landmarks that were removed for new clinical space and the directional orientation.
Sometimes it seems that more people fear going to the hospital because of what hospital buildings have become. People are in fear of not knowing where they will park and of the hospital building that they know they are going to get lost in, more than they fear the exam or treatment that they are going there for and causing added stress to every visit. Something is wrong with this picture. So maybe the change in the healthcare delivery model was inevitable and long overdue, and the healthcare industry is ready to blow up the old tired model and move on to the new one.
Unfortunately the new model for healthcare is becoming the opposite of what we have been doing for the last century. The new model is making the hospital smaller and leaner to house mostly critical care and inpatient services. All other services are moving to outpatient or home settings.
What is the Healthcare Facility Model for 2014 and beyond? While there is not a clear cut answer, here is a partial list of options to start the thought-process and that every healthcare facility can use to evaluate, rank and incorporate for patient satisfaction, recruiting and retaining staff, insurance reimbursement, competitive advantage and affordability.
*College campus atmosphere
*Close, adequate and safe parking, valet parking also
*Hotel-like spaces for patients, visitors and staff
*Education centers for patients and families
*Family spaces that include books, videos, computers, WI-FI
*Adult and child daycare for staff and visitors
*Expanded hours to cater to employed customers 6am – 10 pm
*On-site retail/dining choices
*Expand outpatient services to shopping malls and off-campus locations
*Reduce size of hospital facility and use only for critical care and inpatient services
*Provide hotel/housing for families of patients
*Rehab facilities close to home that look like high-end health clubs
*Lower construction costs by building off campus
*Lower costs for testing and treatments by taking them off campus
*Home visits by doctors, nurses, IV therapy and rehab specialists
*Tele-medicine for rural patients
*Home monitoring for patient’s convenience
*Provide free patient transportation for appointments
*Reduce waste. Reduce waste. Reduce waste.
*Reduce facility square footage
*Reduce energy use and maintenance costs
*Cater to the geriatric market (Boomers)
*Build flexibility and change into every decision that is made
*Expand preventative care medicine offerings
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]