Two years ago, the board of the Facility Guidelines Institute (FGI) discussed the inherent problem in its guidelines for the design and construction of healthcare facilities published every four years: they’re reactionary.
The process itself takes about seven years to see the implementation of new codes in projects, meaning they’re likely already outdated.
So a group of healthcare futurists, providers, authorities having jurisdiction, etc., were brought in to discuss what the major drivers shaping the future of healthcare might be and, subsequently, what's shaping the future of FGI and iterations of its documents.
But it was important to consider that there would, in fact, be multiple forces at play. “If we think about the future as one thing, we almost certainly will be wrong,” said Walt Vernon, CEO of Mazzzetti  and FGI member who took part in the effort, during the plenary session "Health Care Facilities for the Future--New Opportunities for FGI and the Guidelines" at the ASHE PDC Summit in San Antonio.
Overall, 16 forces were identified and measured based on the effect they might have on the trajectory healthcare is on and how likely they were to influence the future. Among them were aging, health status, reimbursement structures, medical devices, mental health, and so on.
Via its colloquiums with those industry minds, FGI determined the two forces most likely to impact the future and that were also the most difficult to predict: reimbursements (whether a value- or volume-based system) and patient engagement (whether high or low), and combinations therein.
For example, highly engaged patients might practice preventive care in their personal lives but be confronted with a volume-based system that nickel and dimes them, pushing them to seek alternatives to traditional care, such as medical tourism.
So then the question evolved into how the FGI guidelines can be created with these forces in mind. While the future is uncertain, Vernon explained, the process identified what commonalities exist no matter what takes shape and how to create guidance around those.
The top 10 lessons learned through the process were:
• The same kinds of services will be provided
• There will be different quantities, concentrations, combinations, and locations of care
• There will be a push to outpatient care in all scenarios
• Residential care will be important
• It’s more about spaces than buildings
• There must be a distinction between fundamentals and what’s beyond fundamentals in the guidelines
• The guidelines should have more flexibility and frequency
• The guidelines should be strongly advised by evidence
• Technology will facilitate more care in outpatient/residential sites and inform details of a space
• The focus on the nexus between operations and the built environment is key.
Kurt Rockstroh, president of FGI, said the organization is moving forward on what it’s learned in a number of ways, including breaking acute care and outpatient care guidelines into separate documents, much like it’s done with residential care guidelines in the 2014 edition.
Also on tap is the creation of “Beyond Fundamentals,” or essentially best practices promoted that go beyond FGI’s traditional fundamentals, or code minimums.