The Future of the Facility

Executive Dialogue Series

Hospitals in the United States face countless challenges, from the workforce shortage to financial constraints and the need to prepare for an aging population. How can hospitals and the built environment help organizations respond to these challenges? How can hospitals prepare for a potential capacity crunch when capital is scarce?

To examine trends in facility design, Health Forum and the American College of Healthcare Architects Nov. 4 convened a group of architects and their health care clients in Chicago.

The Health Facilities Management Executive Dialogue Series brings you frank discussion of issues and ideas by health care executives and industry experts focused on specific challenges facing the industry. This series will appear periodically and is also available online at www.hfmmagazine.com.

MODERATOR (Richard Wade, AHA): Over the past decade, what do you think have been the chief drivers for architects and their clients to think about when they're designing or planning a new facility? Is it different from the way you're thinking today? If so, what has caused you to think differently?

ANN RAISH (Affiliated Health Services):

In my prior life, I was a university hospital administrator. I made the switch from a 1,000-bed hospital to a small community hospital, so I have both perspectives. Consumerism is driving a lot of what design is now. When I first started out in health care, we felt that patients were lucky to get the care we were delivering.

Now, I feel like we really need to be in tune with our patients and our consumers and provide them with what they think they need, or they might not choose us. We are trying really hard to connect to our community and to our consumers to design something that they'll feel connected to and that meets their needs.

Before, we never got patients or the community involved. We designed what we wanted and we were paying for it. We did what we wanted.

KIRK HAMILTON (Watkins Hamilton Ross):

I was going to say almost the same thing. In the 1980s and early 1990s, it was all about money, it was all about what happened with prospective payment and how we could find ways to reduce costs for our clients. People have awakened; there is a clear understanding that the consumer has more choice.

We are entering a whole new era, and the physical facilities are changing as a result of that shift in the consumer world and the balance of power, if you will. Before, we knew what was right and we did it for ourselves. You won't hear that anymore.

FRANCES RIDLEHOOVER (UCLA Healthcare):

I would add one thing to that. Consumerism is certainly a driver, and we've given a lot of thought to interdisciplinary care involving all the caregivers and the patient. We are now putting much more focus on what the family needs so they can be comfortable and supportive of the patient. We are doing that because it helps us.

I think there's an appreciation now that family members who are involved help with patient safety. They help with communication, they help with all the buzzwords we are using now to make sure that there's some coordination of care. If we can involve patients--which means designing spaces for patients' families--if we can involve their families in the care, it's good for the family, it's good for the patient, it's good for us. That wasn't the focus 10 years ago.

JAY LEVINE (University of Virginia Health System):

Twenty-five and 30 years ago, competition wasn't a word that was in the health care field in any significant way. Everyone had a hospital or two or three in their community,. That's knew that's where they'd go to take care of their health needs and that of their family.

Today, the consumer is much more knowledgeable, knows how to use the Internet, knows how to do research. So now, you look at how your design works and how your hospital works relative to the other hospital down the street, be it an academic center or a community hospital. There's competition.

MODERATOR: Has anyone around the table worked on a project in which patients and families come in and participate, and you talk with them?

DOUGLAS MAYORAS (Moon Mayoras Architects Inc.):

It's a real practical approach to design. We're adding daybeds to patient rooms that serve as a couch during the day and then a bed at night. It allows the nurse to not have to bring in or convert a piece of furniture into a bed. We're actually putting in desks for the patient or the visitor to bring in their laptop so they can stay a little bit longer with their family member. These are the kinds of things that I would not have thought too much about in the 1980s. The focus is really on the family member.

PHIL TOBEY (SmithGroup):

It's really an issue of balance. We've talked about consumerism, and that's become more prevalent. We've seen a shift away from focusing on program and working with staff and the physicians and so forth to a much more balanced approach. We're dealing with the consumer on one hand but we are not forgetting about the staffing issues and financial issues and all those. We're looking more holistically at how we design buildings.

KARL SONNENBERG (Zimmer Gunsul Frasca Partnership):

Parallel to some of the discussion about amenities and environment for the patients is amenities for the staff, especially the nursing staff. It used to be that the lounge was the last thing to get squeezed in the corner, with no windows, and it would get smaller as some program function needed to get bigger. We don't see that anymore for the nurses' lounge and the staff lounge because recruiting is so hard. It's got the good views, it's got the outdoor decks in some places because they know they're going to have to really compete for the nurses.

JEAN MAH (Perkins & Will):

That's a really important fact because we're talking about designing for a moment in time that is either an inpatient or outpatient experience at the institution. As the shortage for caregivers grows, family members and friends take on the role of caregiver once the patient leaves the hospital or the ambulatory setting.

Training and educating the family to continue the care or to provide care between episodic care becomes more and more critical. Somehow we have to integrate the training and the education space into the facilities as well and find the people to do the training. This includes physicians but also other caregivers, social service workers, financial types, nurses, whatever, and that's going to be a very big challenge.

RIDLEHOOVER: I think we need to find a way for people to feel they have a home when they're mobile in their work environment, and I'm not sure we've addressed that challenge yet.

MAYORAS: You're right. Lab techs come up to the patient floor, so do dieticians, and we find that the nurse stations get more and more cluttered and people are standing around talking. It's important to try to give them a home as well. What we're seeing is that nurse stations are getting very large. I used to think we were downsizing those and spreading them out. I'm finding they're getting bigger because of the amount of people who end up in them.

LEVINE: It's very easy to plan hospitals if you don't have to worry about the people inside them. We have all learned that. But if you start taking into account the staff and the patients and the visitors, now we've got a problem, and that's why it requires the talent of the people in this room.