As patient, industry, and regulatory demands heat up, hospital administrators are juggling increasingly urgent priorities. What role does the built environment play in meeting these de­mands? For the Healthcare Design feature article “Facility Owners Share Top Concerns In Serving Patients, Staff,” I interviewed executives from hospitals around the country. Gary Constantino, corporate director for Catholic Health System’s office of facility planning, design, construction, and property management (Buffalo, N.Y.),  provided specific details about how his employer is addressing many of the priorities identified as top concerns by a group of owners that met at the Healthcare Design Conference in November. Some of his comments appear in the article linked above; what follows is the rest of our conversation.

What is your overall perspective on how the built environment supports any health system’s goals?
It’s my opinion our built environment is crucial for helping enhance, maintain, improve, and impact a person’s quality of health and life. We view our facilities development, both site and built environments, as an ongoing initiative to make them machines for healing. That is, when opportunities present themselves, we focus on many elements—like the calming influence that landscaping and clear and simple wayfinding has when approaching the hospital. And how to apply the most current air-handling systems technology to improve the quality of air within our environments (enhanced filtration systems; ultraviolet light to help the destruction of microorganisms).  We also install materials with low or no volatile organic compounds, and include multiple lighting sources: skylights above work areas, plenty of natural light throughout, and dimmer-controlled sconces along the corridors. The ability to adjust your light source and levels has been shown to calm the noise and activity in the halls at night, hopefully improving patient and staff satisfaction.

Of the priorities identified for the conference event, which ones resonate the most with you, and why?
All of the priorities listed are of significant importance. 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. But to address some of the specific priorities identified:

Prioritize cost control opportunities and initiatives: Balance efficiency and effectiveness goals.
Within the Catholic Health System, I know that every area of our operation is reevaluating the ways we are efficient and effective daily. 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. 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 environment.

One example is our continuous reassessment and reengineering of our emergency services delivery model. With the involvement of our physicians, nurses, management, support, and ancillary staff, we establish how each individual support function will contribute and operate within a care provider’s environment. Then we begin to design the built environment. Here, the processes create the environment in which they can work effectively and efficiently, and are not forced to fit into the environment.

Promote an integrated approach to care delivery: Facilitate communication between patients, family, and staff.
One approach to integrating our care delivery is through promoting and clearly communicating who we’re aligned with as an accountable care organization. Complete transparency and clear communication to our community continues to build trust and strengthens the Catholic Health brand.

Optimize space utilization and enable adaptability: Respond to both short-term and long-term requirements.
Several years ago we expected that there may be an increase in the amount of unoccupied space in our acute facilities in the wake of accountable care and the anticipated healthcare reform.  We began preparing plans illustrating those areas of our buildings that would be demolished, vacated, mothballed, or repurposed in anticipation of a decrease in the need for inpatient beds. We also planned for some services to expand within our hospitals and larger ambulatory care centers to support an increased need for ambulatory services in those communities. Strategizing which community-based facilities would close and which would be modified and/or expanded to concentrate services as we shift to support population health became an intense focus.

Since then, our short-term space requirements are focused on supporting expected volume within the communities we serve. Our long-term space requirements are in a continual planning mode and are adjusted as market conditions change. We try to be nimble with our reactions to every healthcare climate change.

Build a culture of high-quality care delivery: Dynamically integrate overarching quality and safety goals into daily operations.
As an integrated healthcare delivery system, we continually strive to improve quality and safety by providing ongoing education to our patients, their family and other caregivers, as well as to our providers, nurses, environmental and facility engineering staff, all ancillary and support staff, and our management group at large.

We provide online and classroom educational series at all of our facilities, in partnership with local and regional educational institutions and religious and neighborhood support groups, as well as webinars and health fairs and through the distribution of print materials.

This has been clearly evidenced by the awards and accolades we’ve received: Kenmore Mercy Hospital was named among the top 5 percent of U.S. hospitals for patient safety according to a new report from HealthGrades; Sisters of Charity Hospital was among the top-rated hospitals in New York State for hospital safety, according to a recent study in Consumer Reports; and Mercy Hospital of Buffalo was awarded the 2011 Pinnacle Award for Quality and Patient Safety by the Healthcare Association of New York State.


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