Trendspotting: The Next 10 Years of Healthcare Design
No one can predict the future, but we’re all interested in speculating what it will be like. And the ever-changing nature of healthcare makes it ripe for predictions. Based on a list compiled from conversations with The Center for Health Design’s board of directors, the 2012 HEALTHCARE DESIGN Architectural and Interior Design Showcase jurors were asked what they felt would be the 10 biggest trends affecting the next 10 years of healthcare facility design.
The aging of America
The baby boomer generation is the driver of what is and what will be. This is a well-educated, highly demanding population. And there are a lot of them: 76-79 million. Because of this, we’ll see more hospitals and clinic spaces that support the physical challenges faced by the over-60 crowd. Although no geriatric EDs were submitted for review, jurors acknowledged that these types of facilities are already being designed and built.
“There’s a connection happening between long-term care and acute care in terms of sharing of services and patient types,” says Laurie Placinski, interior project designer, Progressive AE. “So even if patients get discharged from an acute care [facility] and go to a long-term care [facility], they’re still going to end up back in acute care with those shared services. There might be longer stays and more direct transfers.”
New models for senior living that support urban living are also on the horizon, as well as more emphasis on universal design for new or renovated homes so that individuals can age in place.
“There’s a need for more understanding and compassion for older persons,” says Thomas M. Jung, architect and health planner, Thomas M. Jung Consulting, LLC, and a former regulator with the State of New York. “There has to be more everyday awareness of the impact of aging on functioning, and that someday we’ll be that person holding up traffic, moving slowly down the grocery aisle, and crossing the street. The impact of our aging society on design of healthcare is already recognized, but we also have to increase awareness of its impact on design throughout society in terms of residential construction, urban/regional planning, etc.”
The next disruptive technology that will change our lives is just around the corner, but we don’t know what it is yet. Predictive health—keeping people well instead of treating them only when they’re sick—is supported by technology. We’re also seeing the advancement of nanotechnology and more use of telemedicine and home monitoring equipment to observe and treat patients, including “do-it-yourself” diagnostic apps for smart phones/tablets.
This means that the size of the hospital may shrink, but there will be a need to have spaces that support the use of these technologies. Homes may become extensions of the physician’s office.
“Maybe the technology is not there yet to reach people virtually and manage their care, but it’s going to be huge,” says Sarah Bader, principal firmwide practice leader, health and wellness, Gensler. “Coupled with that is your ability to monitor yourself with things like Nike fuel bands and blood pressure tools. All this is going to be one big soup of technological stuff that will help you understand how healthy you are, how to stay healthy, and better communicate with your doctor.”
Designing for technology continues to be a challenge. “What we saw in this year’s architectural review was the continued awkwardness of how to put the computers inside and outside of patient rooms,” says Bruce K. Komiske, chief, new hospital design and construction, Ann & Robert H. Lurie Children’s Hospital of Chicago. “There’s also the TV screen. The problem is that as soon as you get the solution, the technology changes, so two years later it doesn’t work.”
And the future of the OR may be limited, as well. “Every day, we hear about some new advanced technology that reduces the amount of invasive surgery,” says Jim J. Mladucky, director facility planning and construction, Northwestern Memorial HealthCare. “Hospitals are used to patients having a two-hour surgery and staying in the hospital for three days, but today, many patients are there for only 45 minutes before they go home.”
We’re continuing to move from a service economy to an experience economy. For healthcare, this means more focus on the patient as a customer and finding ways to achieve better outcomes at reduced cost. It’s also about empowering patients to have more control over where they get their care and how it’s delivered. Hospital Consumer Assessment of Hospital Providers and Systems (HCHAPS) surveys are filled out by patients after a hospital stay to measure satisfaction and are now tied to Medicare and Medicaid reimbursements.
This means that hospitals are paying even closer attention to the patient experience. The design of the built environment can support an improved patient experience by providing positive distractions through artwork and access to nature and light; places of support and respite for family members; quieter units so patients can sleep, and so on.
“The design team needs to look at the patient experience from A to Z,” says Kim Ritter, associate, director of design, GBJ Architecture, “starting with making an appointment, parking in the garage, and entering the building.”
Bader adds that creating a user-focused experience that is consistent across a health system’s various locations is also critical, while Steven M. Raasch, vice president, director of healthcare planning, Zimmerman Architectural Studios Inc., adds that baby boomers, especially, will continue to have high expectations for their healthcare experience, even though budgets may not exist to support those expectations.
“It’s not so much how we’re going to do more with less, but how are we going to do less with less? This will have a big impact on the idea of experience architecture,” Raasch says.
The concept of healthy living supports a shift from an illness-based to a wellness-based healthcare model, emphasizing physical activity and lifestyle changes at home, work, and in the public spaces that are part of our communities. And many of the projects reviewed by the jury featured garden spaces and pleasant interior stairways to encourage walking.
We’ll see not only more spaces that promote physical activity and facilitate gathering for socialization, but also “walk-to” clinics for routine care, such as eye doctors or dentists, and alternative medicine.
“We want public places and stairs for physical activity, but at the same time, there are accessibility issues with our older population,” says Rod Vickroy, director, North Central health and wellness practice area leader, Gensler. “Solving those two problems at the same time will cause us to think differently and come at it with a universal design perspective.”
Driven by the Affordable Care Act, the U.S. healthcare system is shifting to managed contracts and clinic-based c
are. The days of the big-box hospital may be numbered and, instead, replaced by a smaller “mother ship” surrounded by community clinics, smaller tertiary clinics, and more retail-based clinics. Most drugstores now offer walk-in health services, while flu shots are dispensed at schools, grocery stores, airports, etc.
To discourage people from going to the emergency room for non-life-threatening illness, insurance companies are changing how they reimburse for ER care.
“How will these small retail ‘pop-up’ clinics affect the larger healthcare systems?” asks Todd Cohen, director, special projects, MedStar Montgomery Medical Center. “Because at the end of the day, it’s the bottom line that matters.”
The group says consolidation of the healthcare industry seems inevitable, with some predicting that 30% of the hospitals open now will be closed by 2030. “There won’t be many more big hospitals built,” Komiske predicts. “The bigger question is, what are we going to do with the ones that are already here?”
As the hospital shrinks and becomes a place for only the most acute patients, the home is poised to become an extension of the acute care system. Since home-based care is generally less costly, safer (fewer chances of acquiring an infection), and more family-centered/supportive, there are tremendous benefits for patients.
But many homes are not designed to accommodate people with different abilities and needs that come with illness and/or aging. Universal design will become more important in both new construction and renovation, and there are already several models out there.
One is a home designed by Changemaker Award winner Cindy Leibrock just outside of Fort Collins, Colorado, that has more than 250 design features that support health and longevity. There’s also the Universal Design Living Laboratory, Rosemarie Rossetti and Mark Leder’s national demonstration home, which opened in Columbus, Ohio, in summer 2012.
“Boomers are going to want to age in place,” Vickory says. “Affordability will be a key driver of this.” Adds Mladucky, “The traditional nursing home model hasn’t gone away yet. It’s just changing.”
As care is decentralized, there will be increasing need for spaces to be multifunctional, as well as adaptable buildings that can meet changing modes of delivery and information technology. We’ll see more modular concepts for walls and floors and more mixed-use planning.
Chip Cogswell, national healthcare director, Turner Construction Co., agrees that flexibility is critical. “Inpatient bed floors will never be very flexible, so flexibility needs to be in other areas, especially diagnostic and treatment, and support areas. No one really knows what technology will look like in the future and what it means for a lot of areas,” he says.
“We saw very little response to flexibility in the submitted projects, except in the provision of shell space for future expansion,” says William Worn, president, Worn Jerabeck Architects, P.C., and a professor at the University of Illinois. “Very few new, greenfield acute care hospitals will be built in the foreseeable future. We will, though, do a tremendous amount of rehab and renovation. Unfortunately, this work will be costly and difficult because of the lack of attention to the need for flexibility paid by architects during the past 20-year period.”
Daniel J. Miesle, administrative director – space planning and transition strategy, Stanford Hospital & Clinics, adds that the key to future flexibility will be to design buildings and spaces with standard grids versus specialized spaces, which will be especially critical in terms of high-tech services such as surgery and imaging that could increase room size beyond what is considered “basic needs.”
Creating buildings with longer lifecycles is also imperative due to the continued shortage of access to capital that healthcare providers are facing.
“We need to be building facilities that can be more easily renovated for changes in technology or that can be more easily repurposed,” Jung says. “We also need to keep focusing on lifetime costs. We know the initial first-time cost of constructing a healthcare facility is less than 20% of the total lifetime cost of operating that facility.”
With changes in reimbursement policies driven by HCHAPS scores and other measures in addition to a new focus on wellness based on a patient-centered medical home delivery model, it’s important that spaces are created to foster team-based care.
“There will be more comprehensive outpatient care models that fall just short of inpatient facilities,” Cogswell says. “Kaiser is building these in Atlanta now with everything up to 23-hour beds. Other organizations are going to start moving in that direction. That will be a challenge for those facilities that are heavily inpatient-focused. We’re also going to see fewer large atriums and other ‘nice-to-haves’ and more scrutiny around things that have a true ROI.”
Miesle says that this trend will result in more of an emphasis on electronic medical records and technology interfacing. “We’ll see more comprehensive outpatient centers to include clinics/MD offices, diagnostics, and rehab/wellness,” he says.
In the end, we don’t know exactly what our healthcare facilities and communities that support health will look like in 2021. In the United States, the healthcare system will probably be a continuum of care with the home as the technology-enabled hub, surrounded by retail clinics, wellness and fitness centers, ambulatory clinics, a hospital, and specialty clinics. It’s pretty clear that we’ll still need buildings. Just different types of buildings.
Sara O. Marberry is Executive Vice President of The Center for Health Design. You can follow her blog at http://blog.healthdesign.org/.