In this series, Healthcare Design asks leading healthcare design professionals, firms, and owners to tell us what’s got their attention and share some ideas on the subject.

Raymond E. Brower is vice president with RTKL (Washington, D.C.) and has more than 30 years of experience as a healthcare planner. Here, he shares five top-of-mind observations about what’s driving the shift in healthcare planning and design from large acute-care facility development toward smaller outpatient-oriented projects.

1. Regional care delivery

The development of large healthcare systems is not necessarily new, but the pace of activity recently has led to the renewed importance of multi-campus and regional strategic facility planning. System-wide economics of scale are driving this trend and, therefore, the focus of medical planning has shifted from individual facility needs assessment and future state planning to a broader focus on regional delivery of care. Regional concerns have minimized the historical importance of hospital campus development in meeting the needs of consumers and moved toward a broader understanding of market forces, strategic purpose, and response across a broad array of healthcare settings.

2. Clinical integration

Following mergers and aquisitions activity, strategic planning includes defining the appropriate site of care for major service lines and looking for efficiencies and quality improvements that can be gained through consolidation of service delivery across market areas. For architects, this may mean less new acute-care building projects and more repositioning of existing facilities, both hospital and retail-oriented healthcare spaces. As providers drive for improving their value position, delivering the highest quality care at the lowest cost, renovations can offer the right opportunity to improve operations and patient satisfaction at a reasonable cost. Service line integration may also include the need for new facilities or expansion of existing ones as clients redefine the clinical focus of individual facilities.

3. Lean planning and design

Evidence-based medicine has greatly improved the standardization of care among providers and has had a significant impact on improved care, such as reducing post-surgical infections. Evidence-based design is a growing concept that includes many facets and has, historically, provided somewhat antidotal recommendations regarding the cause and effect of innovative healthcare building design approaches. The ultimate goal is to establish evidence-based care guidelines that can positively impact how we plan and design healthcare facilities. Our clients are asking for healthcare design professionals to engage in this investigative process and contribute to the knowledge base.

4. Community-based outpatient focus

Consumer demand for improved access to services and payment reform are driving the development of community-based outpatient facilities. These strategic assets are part of the broader healthcare system’s response to market forces, strengthening of their physician referral network, and approach to wellness. Ambulatory network planning studies align service offerings throughout the marketplace based upon a study of population centers and overall distribution.

5. Retail medicine

The new horizon involves healthcare as the anchor tenant of commercial retail centers. Large primary care and or multispecialty practices are fast becoming a catalyst for retail healthcare. Another shift is fast care, an evolution of urgent care where non-scheduled appointments are available for a limited menu of services at competitive costs. Many aspects of retail medicine will be delivered by nurse practitioners and other ancillary service providers versus the traditional approach of physician-centric care delivery for low-acuity conditions.

Raymond E. Brower

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