Five-hospital, suburban Philadelphia-based Main Line Health has been in building mode over the past 10 years since Jack Lynch III came aboard as president and CEO. That includes a $200 million investment to upgrade its Bryn Mawr Hospital and the construction of a new $46 million population health-focused facility in Concordville, Pa. Lynch recently spoke to sister publication Hospitals & Health Networks about the challenges of building new health care facilities in complex times.

What would you say to hospital leaders unsure of what to build next or where to invest dollars to the best provide care to their patients?

It's hard. For us, one of the most important things was to try to get a handle on what the bed demand was going to be a year from now, three years from now and potentially 10 years from now. Some of that is guessing and making a lot of assumptions, but I don't think that the trend lines we've been experiencing in the past are going to be the same for the next 10 years.

Some would argue, and we argued for a little while, that inpatient utilization is going to go up with patients living longer, higher acuity and the aging population. In the end, we concluded that, still, the pressures to reduce the need for inpatient admission are going to outstrip the demand for increased beds. We're going to end up decreasing the number of beds while expecting to care for a larger portion of the population in the process.

My comment would be: You've got to really understand your demand and where your patients are going to come from, and what the impact of health care reform and change in practice and standardization in practice are going to do to the demand on your inpatient facilities.

And the other piece is that, if those facilities aren't easily accessible, user-friendly for both the caregivers and the families and patients, they're going to get alternative solutions from somebody else.

How do you build a facility that meets the rapidly changing needs of the patient?

The biggest word our architects and design folks would say that we're incorporating into design is flexibility. If we had to turn the 58 new beds in the new pavilion at Bryn Mawr into intensive care unit (ICU) beds five years from now, it wouldn't require tearing the building down or gutting the unit. It would be relatively easy to increase the acuity of patients in those units based on the need.

Another issue is the size of inpatient rooms. We're thinking about the flexibility required because of the equipment. We're also being flexible about not overbuilding inpatient facilities when we absolutely believe — if we're going to be effective at lowering costs, and improving patient safety and quality — there's going to be a fewer number of admissions per capita than there have been historically.

We're cognizant of the fact that, if we're not careful and we just build beds based on the belief that we can grow the market, we [could] end up with a bunch of buildings that have no patients in them.

What is happening with some of the facility projects you have on the horizon?

We had a decision to make because the one facility needed to be modernized if we were going to continue to provide acute care services on this campus. Because of the demographics, economics, patient population, physician and community loyalty, and inability to absorb all of the volume elsewhere, it made sense for us to modernize this campus.

So, the $200 million we're spending is 100 percent replacement. We're going to build 58 new inpatient beds, 11 new operating rooms, 18 new ICU beds, and enhanced conveniences for patients. There are no new services.

That said, we're reducing the total net bed count at Bryn Mawr by 78. We'll move from mostly semiprivate to mostly private rooms. We are, at the same time, building a medical office that will have a joint venture ambulatory surgery center, and mostly all ambulatory care, including doctors' offices.

We broke ground three weeks ago on the 110,000-sq. ft. multiuse facility with a 50,000-sq. ft. medically oriented fitness and wellness center. Nemours duPont Children's Hospital is going to have an ambulatory component in the building, and we're also going to have an urgent care center.

So, we're reaching into a community where we are trying to grow the volume for patients who seek our services, and we're really broadening our reach with the fitness and wellness program. We're living out the mission we talk about, not just taking care of you when you're sick, but helping you to prevent disease.