While architects and designers are trained to understand the ways in which the built environment can improve the user experience and patient outcomes, for healthcare facility owners, the physical space is just one part of a much bigger puzzle. This is why it’s so important to have an owner’s rep at the table from the get-go—so he or she can understand how a new project will help achieve the organization’s goals and give the facility design the proper attention (and capital) it deserves.

It can be especially productive—and rare—to get a bunch of owners together around a table to consider the challenges of space design within that bigger puzzle. Such a group did convene in November at the 2013 Healthcare Design Conference in Orlando, Fla., with 19 healthcare systems represented from across the country. The group considered a list of 16 priorities in an effort to identify which were the most critical, and how the physical space could support them.

“For some time there has been dissatisfaction with the unbalanced healthcare equation, among patients, insurers, government, and within healthcare organizations,” says Robert Heitmeier, general manager for Nurture by Steelcase (Grand Rapids, Mich.), which organized and hosted the event in its exhibit hall booth. “But in the industry overall, everyone is passionate about making a positive change. In bringing together a small, intimate group of healthcare leaders, it was both reassuring and insightful to hear their common challenges and best practices, all with a focus on bringing about this change as seamlessly as possible.”

Top priorities

Of the 16 priorities identified by Nurture (see “Take Your Pick”, below, for the full list), these five garnered the most votes from the owners panel, and by a wide margin:

  • Promote an integrated approach to care delivery: Facilitate communication between patients, family, and staff.
  • Build a culture of high-quality care delivery: Dynamically integrate overarching quality and safety goals into daily operations.
  • Prioritize cost-control opportunities and initiatives: Balance efficiency and effectiveness goals.
  • Measure improvements in patient outcomes: Understand the impact of the patient care journey.
  • Anticipate and integrate new technology: Integrate technology devices and applications to better support workflow.

The increasing shift from volume- to value-based care, with more empowered patients and a collaborative approach to lifelong health, is evident in these choices. “All of the priorities listed are of significant importance,” says Gary Constantino, health system corporate director for Catholic Health System’s office of facility planning, design, construction, and property management (Buffalo, N.Y.). “We’re collectively working on all of these and more, with safety being paramount. It seems that all other initiatives are simply in support of desired clinical outcomes—specifically, making people well when they are ill and keeping them well when they’re away from our direct care.”

WellStar Paulding Hospital is just a month away from opening its replacement hospital and new medical office building in Dallas, Ga., providing much needed upgrades and expansion to a 50-plus-year-old facility. Says T. Mark Haney, president of WellStar Paulding, “A major emphasis in this facility is to create an environment that removes barriers to communication and integrates the patient, family, and caregivers. Improved communication will lead to improved safety, an improved experience for all three parties, and a stronger discharge planning process.” Some of the design elements that speak to this goal are same-handed rooms, a family zone within the patient room, increased natural light, and 42-inch patient TVs integrated with technology that allows physicians to call up medical records or videoconference with other specialists.

The design solution

Design of the physical environment is playing a big role in addressing facility priorities, according to many of the participants in the event. “Certainly, if we’re going to be investing in new structures or buildings, we want to make sure we’re providing care as efficiently as possible,” says Natassia Orr, chief operating officer at Broward Health Medical Center (Ft. Lauderdale, Fla.). For some, that means taking a Lean approach. Richard Molseed, executive vice president of Avera Health (Sioux Falls, S.D.), says that the first three priorities on the top-five list are all related when it comes to the Lean thinking behind all of Avera’s new and renovated clinics.

“In our older buildings, which we haven’t renovated, there isn’t necessarily any continuity of space or continuity of the equipment,” Molseed says. “But in our clinics, and in any new construction we do, we design or retrofit the physical environment to support the delivery method.” That means different designs to support different kinds of clinics, whether it’s a high-volume family care practice or a less-trafficked neurosurgeon’s office. “When we do this, it builds this culture of high-quality care,” Molseed continues. “We get higher productivity out of our caregivers, higher physician satisfaction, and much higher patient satisfaction at the same time.”

What Avera doesn’t do, Molseed insists, is focus on cost control. “We find that we spend a little more on allocating space, but our return more than pays for it,” he says.

Still, costs are an issue for everyone as reimbursement models change. “Every member of our operation is, in essence, being tasked with re-engineering our process with a focus on reducing or maintaining the current costs to operate while improving outcomes,” says Catholic Health’s Constantino. “I don’t mean clinical outcomes exclusively; other important outcomes are improving air quality, clearly defining the organization’s brand identity, selecting the right materials (not always the newest), improving wayfinding, and establishing the appropriate types of lighting within our diverse environments.”

Additional concerns

Some of the priorities that didn’t make the top five are, nonetheless, of great importance to individual health systems in today’s climate. “Our system goal is to be the employer of choice,” says WellStar Paulding’s Haney. “In planning the new hospital, a focus was to create an environment that enhances the team’s ability to excel.”

Molseed shares the sentiment. “Employee satisfaction is a big priority. We try to involve our employees in design discussions, and we try to make something that works for them on a day-to-day basis. It’s a point of pride: are our employees proud of our buildings? Do they enhance our community? There’s a lot of demand in rural areas here to upgrade facilities. And when we’ve done that, we really do make a positive impression on the entire community.”

The community at large—and, again, the greater focus on long-lasting wellness—was a common theme across the owners’ conversations. “We’re focusing more on wellness,” affirms Ashley Hunnicutt, assistant vice president of business development and real estate for Inova Healthcare (Falls Church, Va.). “It’s about keeping people out of the hospital instead of focusing on ‘the more you touch, the more you’re reimbursed and rewarded.’” Molseed takes it even further: “What is a hospital 10 years from now? We’ve got a mindset around here that in 10 years, if you’re hospitalized—other than for things like childbirth, trauma, or surgery—it means the system has failed you in some way.”

TAKE YOUR PICK
At the owners’ roundtable conducted by Nurture by Steelcase at the 2013 Healthcare Design Conference, owners were asked to choose their top three priorities from the following list. In bold are the five highest vote-getters.

  • Deliver positive experiences: Identify opportunities to reduce or prevent patient and family stress.
  • Prioritize cost-control opportunities and initiatives: Balance efficiency and effectiveness goals.
  • Attract, engage, and develop clinical staff: Develop recruiting and retention strategies focused on the diverse needs of individuals.
  • Promote an integrated approach to care delivery: Facilitate communication between patients, family, and staff.
  • Optimize space utilization and enable adaptability: Respond to both short-term and long-term requirements.
  • Acknowledge that patients have choices in care providers: Deliver patient experiences that are preferred over other providers.
  • Support the mental and physical work demands of clinical staff: Identify opportunities to positively impact staff satisfaction levels and well-being.
  • Define aspects of patient satisfaction: Align care delivery goals with patient expectations.
  • Build a culture of high-quality care delivery: Dynamically integrate overarching quality and safety goals into daily operations.
  • Consider the impact of process innovation and evolution: Understanding the relationship of people, process, technology, and space.
  • Express identity and image: Connect patients, family, and staff with your brand.
  • Support the precepting and collaboration of clinical staff: Enhance the transfer and exchange of knowledge.
  • Promote sustainability initiatives: Implement green practices within the organization.
  • Anticipate and integrate new technology: Integrate technology devices and applications to better support workflow.
  • Enable staff to concentrate in an intense care delivery environment: Recognize the tensions of accessibility, privacy, and concentration.
  • Measure improvements in patient outcomes: Understand the impact of the patient care journey.

 

For more owners’ perspective on the evolution of the built environment, see: