Healthcare Facilities of the Future

As the COVID-19 pandemic has challenged America’s hospitals and other healthcare facilities, leaders have been challenged to reconfigure their facilities to provide safe, accessible care. Administrators have found innovative ways to expand isolation wards, ensure access to critical equipment and redirect foot traffic to ensure the safety of patients and staff. As they look to the future of both existing and planned facilities, there is no doubt that healthcare organizations will be keeping these priorities in mind.

In a discussion with Modern Healthcare Custom Media, three industry experts discussed how leaders can factor this risk into their capital asset planning and shared best practices for transforming the physical environment to overcome the challenges of COVID-19.

Panelists:

Manuel Hernandez is principal - strategic innovation and health care market leader at Kahler Slater. As the only clinically active physician in the US with advanced degrees in medicine, business and design, Dr. Hernandez leverages data-informed approaches to guide health systems to unsurpassed success and innovation.

William Schlein is the healthcare practice leader at LS3P. Willy brings over 25 years of visionary healthcare experience as LS3P’s Healthcare Practice Leader. Willy recently led LS3P’s design team for the World Health Organization’s first COVID-19 hospital in Burkina Faso, Africa.

Richard Taylor is division president of JLL Healthcare Solutions. He leads JLL’s Healthcare Solutions business and advises healthcare organizations on improving the patient experience, mitigating risk and improving financial performance through real estate and facilities.

MH: Failing to plan properly harms patients, stresses families and pushes staff to the breaking point. We must redefine success, striking the right balance between what we must do to meet community need and ensure long-term organizational sustainability. We must also become more nimble: our spaces, people, operations and technologies need to quickly adapt to the demands being placed on the system.

WS: Preparation for the next event, based on successes and failures evident in the current environment, will be critical to survivability. Staff preparedness, facility readiness, public health messaging and management, medical equipment availability, and coordination of local, state and federal healthcare services will all need re-evaluation and re-tooling in terms of lessons learned for the next pandemic or environmental event.

RT: Real estate flexibility is key. Is there ability to convert a wing to negative pressure? Some health systems rapidly converted lobbies into emergency rooms because they had the infrastructure. Organizations should also have a strong business continuity plan, from identifying technology to succession plans. Organizations should also have a strong network of suppliers, resulting in benefits from achieving economies of scale to contract guarantees.

MH: The adapting of facilities should focus on all types of risk, not just those posed by COVID-19. Along with social distancing strategies, emphasis needs to be on segregating patient, visitor, staff and logistical flows, and minimizing contact between contagious and non-contagious flows during pandemic response situations. This will allow revenue-generating services to operate separately from pandemic response activities.

WS: Providers will need to implement building responses that inherently facilitate antiseptic personal and communal behaviors such as one-way traffic, minimal surface touching and similar precautionary behaviors that “lay on top of” architecture. Strengthened design responses will include negative pressure in patient rooms (and elsewhere), increased corridor widths, antimicrobial materials and interactive data interfaces for smart phones.

RT: Create a taskforce comprised of facilities, infection control, patient privacy and human resources staff to heighten safety. Develop new standard operating procedures to ensure your organization is aligned. Publicize safety measures externally. When patients understand these ahead of time, they’re more likely to comply. Thoughtfully plan patient pathways and add floor markers and physical barriers to protect employees and patients.

MH: Geofencing and Real-Time Location Systems (RTLS) create safety in situational awareness, and when combined with self-service kiosks and apps, promote socially distanced and contactless experiences for arrival, check-in and departure. Internet of Things (IoT) technologies can provide real-time information about the status of soap and paper towel dispensers, ensuring uninterrupted access. Leveraging machine learning to analyze safety and infection control practices can guide solution development.

WS: Building elements will become more technologically integrated for active and passive viral safety. Technologies like temperature scanning, touchless elevators, antimicrobial materials and foot-pull door openers will be incorporated into buildings. ADA requirements will require re-thinking for safety protocols; for instance, foot-pull doors will not work for those in wheelchairs and braille signage will need to be made antiviral.

RT: Technology is essential in assessing overall portfolio and reimagining layouts. Advanced workplace and asset management tools add ease to daily tasks, and providers can eliminate paperwork with electronic check-ins for patients. Leverage telepresence systems to facilitate patient outreach, and install video intercoms for contactless operations. Thermal temperature screening can be used for patients and their companions, wave operators can also be used for touchless door opening.

MH: Most people believe what they see, not what you say, so we need to be more intentional in demonstrating our efforts to keep everyone safe. We’re all following CDC guidelines, but many people don’t understand what that really means. They need to see us taking actions to keep them safe, to show them we’re being intentional about safety, and we must be consistent. We should also bring them into the process much like the airlines are doing today.

WS: Providers will need to publicize continued messaging regarding social distancing and personal hygiene from the CDC, WHO, states, and academic and local medical systems. LS3P recommends placing concierges (along with clear, simple graphics) to help guide and communicate safe building interactions. These concierges also alert facilities staff when building elements require cleaning or when PPEs are not being properly used by visitors or staff.

RT: Proactive, consistent and reassuring communication is imperative. Amplify communications to your community through advertising or local news. Add signage around your facilities, near entrance areas and throughout patient pathways. Be mindful and provide guidance for visually impaired and disabled. Ensure that staff members who interact with patients consistently communicate your safety protocols as well, prior, during and after appointments.

MH: You need environments that facilitate digital experiences for people who want them and analog experiences for people who don’t. Spaces need to embrace newer, smaller technologies and equipment that must easily and efficiently interface with one another. This shift adoption will mean fewer exam rooms, fewer transfers to higher levels of care, smaller support spaces and completely reimagined workspaces.

WS: Twenty to thirty percent of exam rooms are being converted or planned for telemedicine spaces, reducing visitor and staff traffic through clinical spaces and lowering waiting room density. Telemedicine increases the need for equipment and data spaces, and also increases heat loads and data/electrical requirements. Telemedicine will require re-thinking lighting, acoustics, room fi nishes, furnishings, and computer and camera quality for high-performance diagnostics.

RT: Develop telehealth provider suites, as practitioners still need space for calls or electronic communications, remote monitoring and other virtual care functions. Reconfigure space based on data analytics and repurpose newly available space—these areas could be recaptured for telehealth support. Reimagine the potential for live practice: services like behavioral health gain value from in-person visits, as diagnostic protocols are captured in non-verbal cues.

MH: Pulsed xenon disinfecting units support faster terminal cleaning. Electrostatic cleaning technologies clean up to 18,000 square-feet per hour. Staff RTLS tracking identifies what areas have been cleaned and when. Autonomous cleaning machines can continuously clean floors while staff focus on other surfaces. We can also learn from industries like airlines which hand out sanitizing wipes for passengers to wipe down spaces airlines crews have already cleaned.

WS: Designating one employee each day who is dedicated to cleaning rounds of all areas—and alternating this staff person daily—can provide enhanced cleaning without increasing FTEs. Practitioners should work with designers to target 50 percent of normal capacity, and encourage employees to work from home when possible.

RT: Remove items such as plants, non-essential displays and excess furniture to streamline cleaning and reduce infected surfaces. Utilize easy-to-wipe surfaces—such as wall coverings, furniture, screens—that can be thoroughly cleaned. Create a standard rotational schedule of cleaning, and try creative measures for disinfecting, like UV-light sanitizers. Providers can also close certain public restrooms and other areas to minimize cleaning time.

MH: A pandemic, a rapid spike in unemployment and an overnight telehealth revolution has upended capital asset planning. Future needs will differ for every system. Leaders need to start with a rapid assessment of market needs and corresponding capacity and facility requirements. This information can be used to prioritize future investment based on your success metrics and maximize ROI while better aligning service location with demand.

WS: Future pandemic readiness must re-define how we use health care buildings. Can buildings be scheduled in shifts or used 24/7, and hence be smaller? Can services be offloaded from hospitals to more cost-effective real estate? Can ambulatory services remain operational—for the sake of cash flow and community health—during future pandemics and natural disasters? Preparation based on experience and data will define future responses.

RT: Healthcare providers are facing a tremendous financial burden. Through capital planning, prioritization and other real estate levers, organizations have opportunities to reduce costs and think ahead. Advances in facility infrastructure and efficient energy and sustainability plans can carry them through crises operationally and financially. Real estate flexibility, data and creativity are invaluable in reimagining healthcare facilities.