Healthcare facilities are about as complex a building type as you can get, making a career in the healthcare planning and design field far from a cakewalk. And market conditions are only complicating matters. Hospitals and health systems are responding to the financial realities of reform (and remaining unknowns tied to the Affordable Care Act), implementing measures to support population health, and trying to figure out what to do with an aging building stock—each priority shaping expectations for new building projects and, more importantly, the project team members delivering them.

Healthcare A/E/C firms are responding to the new climate that’s been created, one where shorter schedules are the norm, collaboration is key, and expertise is a must. Healthcare Design asked healthcare design leaders to shed light on the business side of the industry today—specifically, what challenges are top of mind, from talent acquisition to streamlining project delivery to answering evolving client expectations.

In this special report, we profile not just those challenges identified, but the drivers behind them and the solutions being implemented. Here, Chuck Siconolfi, medical master planner, principal at Perkins+Will discusses his firm’s efforts to tackle client expectations for availability and responsiveness.

Name: Chuck Siconolfi
Title: Medical Master Planner, Principal
Firm: Perkins+Will (New York)
Number of employees: 2,284
Healthcare revenue in 2016: $90.1 million


Business challenge: Supporting clients in uncertain times
Funding structures for the provision of healthcare services are changing, yet no one can say how or what the ultimate impact will be. As the need to control cost persists, healthcare systems face unprecedented challenges in planning how to serve their communities. For healthcare design firms, this translates into the challenge of how to best serve clients. In some cases, new or renovated facilities will be the answer; for others, new service models. The solution must be determined by the assessment of a health facility’s physical infrastructure.

Recent attempts to change the way healthcare services are funded have left many questioning what the future holds. But it’s important to look at what’s to come: New technologies will deliver new treatments, the population will continue to age, and the demand for services will be strong. Hospitals and healthcare networks will need to develop new, advanced strategies to meet those needs and provide quality care, and make facility and real estate decisions that support those strategies. The design community must support them with these efforts.

What’s behind it
We are, in a sense, in a good position to reinvent the future of healthcare. Science is progressing every day and delivering more effective treatments than ever before. This is due to advanced technologies that are providing new ways to interact with and discover treatment patterns buried in all the data that patients generate during the receipt of care. Additionally, population health strategies (or value-based strategies) have the potential to realign incentives toward disease prevention. These trends are complementary and will help to control providers’ costs.

In the short term, there’s concern that a large percentage of those who gained insurance coverage through the Affordable Care Act —especially in states that accepted the Medicaid expansion—will lose that coverage as the federal government curtails or withdraws health insurance subsidies.  When coverage is lost, neither illness nor wellness are managed. People present at emergency departments with chronic episodes of what would otherwise be manageable conditions, and they present in a much worse state. This uncompensated care delivered by providers is associated with an increase in costs to hospitals, taxpayers, and those with insurance.

Conditions like these make it difficult for healthcare providers to move forward and plan new healthcare facilities. The immediate challenges for healthcare providers are to understand new and emerging healthcare models, the incentives that are created or eliminated, and the programs that must be supported.

The solution
Consider the intersection of healthcare and payment models. In markets with a high percentage of revenue in fee-for-service models, inpatient days per 100,000 people equates to about 120 days. In markets with a high percentage of value-based healthcare arrangements, the number of inpatient days for the same population equates to about 60 days.

As designers and planners, we must be prepared to understand the effects of these changes on our clients, to assist in the quantification of those impacts, to evaluate the suitability of the physical assets of a health network, and to develop new design solutions. In this, we can offer solutions to our provider clients that respond to the changes in their business and healthcare models. A new building may not always be the answer, but a combination of health strategy assessment, facilities assessment, and future scenario testing can provide our clients with the best match between their goals and the tools they use to deliver them.

To quantify the effects of these changes, utilization studies of key service modalities and demand studies can be conducted. The latter often requires close cooperation between the design team and strategic planners. A facilities assessment process can inform the client and the design team about the extent to which current facilities support their evolving mission and needs.

Considerations today include the need for more ambulatory care services with greater interventional capabilities and virtual connectivity to be located closer to the communities they serve. Additionally, inpatient environments will continue to require replacement because existing facilities don’t provide single patient rooms and high degrees of safety and efficiency. Facilities will also be needed to house staff who manage remotely monitored patients, and these spaces may also evolve to support the staff who supervises and renders in-home care.

Words of wisdom
Designers and strategic planners working in concert with healthcare providers can answer the reductive forces of wellness, improved healthcare models, technology, and value-based compensation. This is contingent upon the growth of insured individuals, the overall population, and the aging population. They can also match that balance to the physical structures in which a health system operates.