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

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.

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.

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.