Flex­i­ble fa­cil­ity de­sign, man­age­ment ap­proach crit­i­cal in era of un­prece­dented in­dus­try change

Modern Healthcare - - COMMENT - By Deb­o­rah Shee­han In­ter­ested in sub­mit­ting a Guest Ex­pert op-ed? View guide­lines at modernhealthcare.com/op-ed. Send drafts to As­sis­tant Man­ag­ing Editor David May at dmay@modernhealthcare.com.

Amid con­stant mar­ket con­sol­i­da­tion, evolv­ing tech­nol­ogy and clin­i­cal in­no­va­tions, and chang­ing re­im­burse­ment strate­gies, health or­ga­ni­za­tions must cre­ate so­lu­tions to suc­ceed in a less pre­dictable en­vi­ron­ment, re­think­ing their ser­vices, care mod­els and real es­tate strate­gies. The shift­ing healthcare land­scape—from the fi­nan­cial im­pact of Med­i­caid ex­pan­sion to grow­ing con­sumerism in the in­dus­try—re­quires thought­ful fa­cil­ity-de­sign ap­proaches driven by strate­gic so­lu­tions that re­spond to short- and long-term needs.

Mov­ing from “can we?” to “should we?”

It is more crit­i­cal than ever for health or­ga­ni­za­tions to de­ter­mine if they are of­fer­ing the strate­gic and ap­pro­pri­ate ser­vices. Just be­cause an or­ga­ni­za­tion can of­fer a ser­vice in a lo­ca­tion does not mean it should. Or­ga­ni­za­tions that bring fo­cus to their of­fer­ings can grow qual­ity ser­vices in re­sponse to dis­ease in­ci­dence, in­crease mar­ket reach in re­sponse to de­mand, and po­si­tion them­selves strate­gi­cally in con­trast to com­pe­ti­tion.

At Bay­health in Delaware, the or­ga­ni­za­tion had a dif­fi­cult time re­spond­ing to an as­sess­ment of its need for ob­stet­ric ser­vices be­cause it be­lieved the ser­vice was a pre­req­ui­site for a com­mu­nity hos­pi­tal. Ev­ery in­di­ca­tion eval­u­ated, such as pa­tient vol­ume, de­mo­graph­ics etc., demon­strated this was a ser­vice aligned solely with its mis­sion as a com­mu­nity hos­pi­tal but no longer re­spon­sive to need or cost in­di­ca­tors.

Uni­tyPoint, which serves mar­kets in Iowa and Illi­nois, faced sim­i­lar chal­lenges when it eval­u­ated its mul­ti­ple Quad-Cities lo­ca­tions and saw heavy over­lap in pri­mary and sec­ondary ser­vice ar­eas across lo­ca­tions. Through anal­y­sis, the or­ga­ni­za­tion be­gan to be se­lec­tive about which sites of care would of­fer key car­diac ser­vices. Uni­tyPoint re­al­ized the value of con­sol­i­dat­ing its clin­i­cal horse­power, mov­ing to a model that al­lows it to achieve higher ef­fi­ciency and higher qual­ity mea­sures in out­comes by uni­fy­ing car­diac ser­vices in a sin­gle branded cen­ter of ex­cel­lence.

A need for flex­i­ble fa­cil­i­ties

Re­im­burse­ment pat­terns can change rad­i­cally in to­day’s healthcare en­vi­ron­ment. At Bay­health, the im­pact of ser­vice-line con­tri­bu­tion changed sig­nif­i­cantly in 2015 when Med­i­caid rates were re­set, re­duc­ing net ser­vice com­pen­sa­tion by 28%. This il­lus­trates that health or­ga­ni­za­tions need to have ag­ile real es­tate as­sets that al­low them to re­think ser­vice of­fer­ings and re­con­fig­ure phys­i­cal spa­ces quickly if nec­es­sary.

Utiliz­ing a stan­dard­ized struc­tural grid pro­vides one so­lu­tion to the elu­sive goal of “fu­ture proof­ing” a health sciences fa­cil­ity. A “uni­ver­sal grid” con­sist­ing of the op­ti­mum set of ver­ti­cal and hor­i­zon­tal di­men­sions for a build­ing’s struc­ture can help. Vet­ted for en­gi­neer­ing sound­ness and con­struc­tion ef­fi­ciency—pro­to­type health fa­cil­i­ties can be de­signed that ac­com­mo­date a wide range of po­ten­tial uses.

De­signs em­ploy­ing the uni­ver­sal grid have proven al­most in­fin­itely adapt­able. More­over, fa­cil­i­ties lever­ag­ing the grid can re­duce the typ­i­cal 10- to 18-month span from fa­cil­ity plan­ning to ground­break­ing by up to 80%. At Washington Univer­sity Med­i­cal Cen­ter in St. Louis, ground­break­ing for a 750,000-square-foot bio­med­i­cal re­search fa­cil­ity based on the uni­ver­sal grid ap­proach oc­curred in less than five months from the start of de­sign, fast-track­ing oc­cu­pancy, sav­ing in ex­cess of $5.5 mil­lion in plan­ning costs and ac­cel­er­at­ing rev­enue cy­cles.

In am­bu­la­tory care, mod­u­lar plan­ning can al­low health or­ga­ni­za­tions to flex up and down based on clinic size, de­mand and spe­cial­ties re­quired to sup­port di­ag­nos­tics for this pa­tient pop­u­la­tion. As an il­lus­tra­tion, if you have two providers in the af­ter­noons on Tues­days and Thurs­days and now want to add a third, you need a fa­cil­ity that can flex to ac­com­mo­date use pat­terns based on day of week and time of day.

More or­ga­ni­za­tions are ask­ing the nec­es­sary hard ques­tions and de­vel­op­ing out­comes-based so­lu­tions that bring clar­ity to their ser­vice strengths, high­light­ing where to in­vest for growth and where to divest be­cause of sat­u­rated ser­vices, cost-pro­hib­i­tive oper­a­tions and/or weak ser­vice de­mand. The value of de­sign think­ing in part­ner­ship with ser­vice providers to eval­u­ate fu­ture con­di­tions and de­velop cre­ative ap­proaches will help them thrive amid un­prece­dented in­dus­try change.

Deb­o­rah Shee­han is ex­ec­u­tive di­rec­tor of the healthcare prac­tice at Can­non­De­sign, a global in­te­grated de­sign firm.

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