As the cost of providing healthcare services continues to rise with no end in sight, grim news reports often cite our aging population as one dimension of the problem.
These reports almost never mention another problem related to aging: Our healthcare facilities are getting older, too.
It's a serious problem. If your building is 20 years old, many areas are probably functionally obsolete. And many hospitals have areas still in service that date back 40 years or more. Most are located on campuses that are now too small to support needed expansion. Some have building code issues that couldn't be resolved even if there were unlimited funds for renovation, which is never the case. Some aging hospitals, particularly in rural areas, were constructed quickly and cheaply under the Hill-Burton Act during the 1950s and 1960s. These facilities are now inefficient to staff and operate, a real detriment at a time when qualified nurses are in short supply. In some cases, the buildings' poor condition compromises the quality of hospital services and exacerbates such problems as infection control.
Hospitals with aging facilities are caught on the horns of a dilemma. They face intense pressure to reduce the cost of delivering healthcare just at the time when they desperately need to make a big financial investment in their facilities.
Many opt to renovate one or two key service areas and/or build an addition without even considering replacement. But even after renovation, most end up with a facility that's still largely obsolete and inefficient.
Some hospitals don't even consider replacement because they believe the cost will be too high. Others refuse to consider it for sentimental reasons. The decision to tear down or leave an existing facility is always controversial.
But often, it's the right decision. Jefferson Memorial Hospital in Jefferson City, Tenn., is reaping the benefits of its board's decision to build a 58-bed replacement facility five years ago. The decision was easier than most. Rebuilding proved far less costly than renovating the existing facility, a 1950s-era Hill-Burton relic, because the costs of addressing the old facility's codes and other issues were astronomical. The new facility has attracted more physicians and staff as well as new patients, mainly people in the community who had formerly gone elsewhere for inpatient care. Jefferson Memorial now is planning an expansion.
At the opposite end of the spectrum, Baptist Memorial Health Care Corp. in Memphis, Tenn., experienced a precipitous decline in its average daily census at its downtown tertiary-care center from 1,200 to 1,300 during the 1980s to 300 to 400 by 1996. Renovation of the Baptist complex was impossible because of the buildings' size and codes issues. Much of the downtown space the system was paying to heat, cool and maintain was empty. But the downtown facility housed several tertiary services available nowhere else in the Baptist system and a medical residency program. The complex also was a historic downtown landmark.
With the support of the Memphis community, the Baptist system made a courageous decision to close Baptist Memorial Hospital and shift its tertiary services to two suburban hospitals. At the system's East Memphis campus, construction of a new "heart hospital within a hospital" and a freestanding women's hospital created enough capacity to accommodate tertiary programs transferred from downtown.
In Vicksburg, Miss., River Region Medical Corp. merged two existing hospitals. The system originally planned to renovate and expand the newer of the two facilities, but departments were scattered throughout the building in the existing facility-resulting in double staffing of some areas-and spaces weren't adaptable. An analysis proved that the cost of constructing a replacement was more than justified by the operational savings the system could achieve by building a new, more efficient hospital. This highlights a valuable insight: Construction costs that sound high suddenly seem minute when compared with the cost of operating an inefficient hospital over several years. When efficiency improves, the dramatic effect on operational costs pays off quickly and then continues to add to the hospital's bottom line.
Complete replacement is not always possible or even desirable. Centennial Medical Center consolidated two Nashville hospitals-Park View Medical Center, built in the 1960s, and West Side Medical Center, built in the 1970s. Both facilities represented major capital investments and neither was completely obsolete.
Fortunately, the campus was large enough that both existing hospitals could be adapted for reuse. The West Side building became a dedicated women's and children's hospital. A portion of Park View was converted to an outpatient oncology center, with the remainder remodeled into physician offices. And the operational problems plaguing the hospital's inpatient units and clinical departments were resolved by the construction of a new building to house Centennial's expanded range of tertiary services. Like Jefferson Memorial, Centennial benefited from an influx of new physicians, staff and patients to the modern facility.
Replacement sounds like a costly and radical solution to aging facilities-and it is. But rising operational costs mandate buildings with layouts and functional adjacencies that support efficient operations and with systems that don't waste energy or require constant maintenance.
You may be surprised to find that replacement is less costly in the long run.
Richard Miller is president of Earl Swensson Associates, a Nashville-based architectural firm.