Managed care might seem to be putting a damper on healthcare construction, but in fact it's one of several industry changes creating more opportunities for architectural and building firms.
Although construction of new inpatient-care facilities may be slowing down as a result of managed-care pressures, renovations, additions, and new ambulatory and long-term-care centers continue to be on the rise, according to MODERN HEALTHCARE's 18th annual Design & Construction Survey.
With hospitals constantly changing hands, consolidating or investing in physician groups, there is plenty of demand for help in rearranging the architectural furniture.
Among the trends fueling this demand are the following:
Consolidation of facilities and departments is leaving many unoccupied rooms.
Equipment is being reduced because of centralization. But that consolidation is creating demand for design of new central facilities.
New technology is bringing new space requirements.
Ambulatory-care centers are growing at breakneck speed, especially in rural areas. Created to reduce the cost and length of stay in inpatient facilities, these centers are becoming more specialized and are focusing on patient-centered care.
As baby boomers near retirement age, the number of assisted-living facilities will continue to skyrocket. According to Zweig Market Intelligence Reports, it's estimated that one out of every five people will be 85 or older by the year 2045.
Although MODERN HEALTHCARE's survey showed a 2.5% decline in completed projects in 1996-3,290 vs. the 3,385 completed in 1995-there was almost a 6.5% increase in the number of projects that broke ground and a 2.4% rise in the number of projects designed. Dollar volume of $15.2 billion in 1996 was 10% lower than the $16.9 billion in 1995 because of the decrease in completed projects.
Of the 177 respondents in MODERN HEALTHCARE's survey, 132 were architectural, 13 were construction management, 11 were design/build, 15 were general contractors and six were program managers.
New needs. Respondents reported their clients are looking to build leaner, more efficient facilities.
"With limited capital funding, facilities need to continue serving the patients, stay competitive and make a profit," says Marlene J. Berkoff, senior vice president in the San Francisco office of architecture firm Ellerbe Becket. "Some of these facilities are doing strategic facility planning and deciding where they are going to invest limited resources. Besides determining how these arrays of facilities are going to be structured, operational efficiency and quality of care need to be kept at optimum levels."
Another consideration is changing technology.
Advances such as digital imaging, teleconferencing and computerized medical records will have a tremendous impact on the design of rooms.
Moreover, the days of bedside charting are numbered, and wireless technology is in vogue. Through a hand-held portable radio transmitter, a doctor can send the latest patient information to a centralized computer system.
But communication isn't the only kind of technology affecting healthcare delivery. Medical technology such as minimally invasive surgery, lasers and magnetic resonance imaging devices call for well-designed suites. For example, ambulatory-care centers are performing minimally invasive surgery, aided by monitors.
"These monitors should be within ceiling-mounted carriages that enable more mobility for the staff and floor-situated equipment," says Wayne Estopinal, president of Estopinal Group Architects in Jeffersonville, Ind.
Networking. Richard Miller, president of Earl Swensson Associates in Nashville, notes that integrated networks are supposed to enhance service, eliminate duplication and cut costs in the long run. Samaritan North Health Center in Englewood, Ohio, which was designed by Swensson, is a good example of architectural design for integrated networks. Approximately eight miles from Good Samaritan Hospital and Health Center in Dayton, Ohio, this ambulatory-care facility features an array of diagnostic services, a pharmacy, child care and a health information library.
Russ Sedmak, vice president of the Denver office of the architecture firm HLM, points out that hospitals and networks are turning more to outpatient services and diagnostics, for which they are building separate campuses.
Florida Hospital Waterman in Eustis is adding an outpatient facility scheduled for completion in May. The hospital's current inpatient facility is located on a separate campus. An inpatient function will eventually be added to its new campus, and the old campus will be closed. The 121-acre campus designed by Estopinal Group is fronted by three lakes. Community volunteers, physicians and political interest groups in surrounding communities all have had an opportunity to comment on the design. The project grew from two stories to three because of an overwhelming response from the community.
Patients at the center. Patient-centered care continues to be an important element in design, with 22% of respondents reporting in this year's survey that they practice it.
Patient-centered care is based on the premise that too much time and money is being spent on nonclinical tasks like paperwork. This model works to eliminate waste, reduce documentation and simplify delivery of supplies.
Patient-centered care thus presents problems as well as benefits. For example, greater efficiency can result in a reduction in staff. But that means the workload is shouldered by a smaller number of employees. The design answer to this challenge is clustering of services combined with cross-training of staff.
Robert Sharrow, assistant director of healthcare services for the Detroit-based architecture firm Albert Kahn Associates, says designers need to move beyond patient conveniences.
"We need to take into consideration the staff and family, because without their efficient help a patient cannot heal entirely," Sharrow says. His firm designed Trinity Medical Center in Moline, Ill., which is scheduled for completion this summer. The center includes comfortable staff spaces aimed at raising morale. Staffers, like patients, need quality food, privacy and serene surroundings.
But no one is suggesting the patients be forgotten. At some facilities there is an all-out effort to make the surroundings as pleasant as possible. For example, an ambulatory-care facility completed last December at Jersey Shore Medical Center in Neptune, N.J., includes several crowd-pleasers such as an attractive lobby and a greeter whose functions are similar to those of a concierge.
Assisted living. Assisted-living centers are likely to increase in popularity as those aging baby boomers try to hold on to some autonomy. In addition, the price for this kind of living is lower than the traditional nursing home.
Although there wasn't a significant increase in the number of assisted-living facilities built last year-57 completed in 1996 vs. the 55 completed in 1995-architects say the number of these facilities will continue to grow over the next few years. The design survey shows that last year 160 such facilities were designed, 25% more than the 128 in 1995.
Karen Hargarther Thomas, principal of the San Francisco-based architecture firm Stone Marraccini Patterson, says 10% to 15% of the healthcare work that SMP does is devoted to assisted-living centers.
The Terraces at Los Gatos, Calif., sponsored by American Baptist Homes of the West, is an SMP project completed in 1994. It combines independent living, assisted living and skilled nursing on its campus. There are no vacancies in assisted living.
Thomas says three other hospitals-one in the Midwest and the others on the East and West coasts, all of which she declined to name-have asked SMP for advice on opening assisted-living facilities.