Highlights of HC Leader Predictions

Posted on February 3, 2014

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The final 2013 issue of Medical Construction + Design offered some “predictions” by healthcare leaders on “thoughts on the facility of tomorrow”.  Although these are more wish list items than true predictions, there are some truisms and good ideas buried in here:

  • Better air flow to prevent spreading infectious diseases

It is surprising how few beat the infection control drum.  It is a practical focus for sure, and a clinical one, but one that has a big potential downside for hospitals if not managed.  And all it takes is one costly slip.

  • Compact, efficient buildings with short walking distances

Universally applicable tools like simulation are helping to solve complex questions like “What is the best spatial arrangement that provides  1)  the most efficient spatial arrangement for clinical outcomes, and 2) provides clinical staff with the shortest walking distances?”  We can definitively answer questions like these with quantitative data.

  • Larger patient room bathrooms, pocket doors

Bathrooms are a thankless place to add space.  Unless a unique facility issue is lurking, like a high fall rate, owners usually ask for smaller bathrooms.  If this request comes up with a client, it is an appropriate time to ask “why” to ensure larger bathrooms would treat a legitimate root cause, not a symptom.

  • Un-clutter patient rooms

“Clutter” is in the eye of the beholder.  One doctor’s clinical need is another’s clutter.  Without more information, it is difficult to know what was meant by this response.

  • Spaces for group patient forums and meetings

I find this interesting because it begins to address the changing philosophical role of hospitals as ‘places where the sick go’ to ‘places where you learn to become well’.  Hospitals have traditionally not been socially focused from the patient perspective (i.e. gathering patients together to learn), nor community education-focused (i.e. bringing people into the hospital to learn).  However, I see this as an important distinction and role evolution in the near term.

  • Patient education:  “This may require the passing of an entire generation to teach the patient population how to navigate the new health system.”

Our society’s understanding of healthcare is based on decades old assumptions because healthcare has been a slow-to-change industry.  Many aspects of post-reform healthcare we have yet to experience will require a re-acculturation.  And for some concepts, like the roles of technology and the individual in managing personal wellness and healthcare, it will take a generation—both for the patient, and for the care providers—to take hold.

  • “A better balance between architectural / artistic high-end hotel-like environments and the mission must be achieved.  There must be a balance between healing environments, technical needs and cost.”

The cost and quality of design as it relates to outcomes and patient satisfaction is highly debated.  More study is required.

  • “Key cost controls include risk sharing, managing by exception, optimizing productivity, staffing to daily census / volumes, including support services, avoiding nice-to-haves and simply being great stewards of business resources.”

There is a lot to chew on here.  What I read is more accountability in the system, and using real data to make smart decisions…all soon to come and within reach.

  • “While our age of plant is a concern, our IT financial commitment must come first.”

This comment is evidence of the abrupt evolution of IT prominence in healthcare—often at the expense of other parts of the “machine”.  IT’s appetite for growth, and associated cost, is a hard-to-manage yet real budget conundrum for healthcare systems.

  • Overhaul of operating room design:  “we’re retrofitting technology into an OR configuration that was designed in 1889 by Dr. Charlie Mayo.”

I find this a chicken-and-egg situation that does not need to be.  Retrofits are an economical way of improving a space when a total redo is not an option.  Yet, an OR layout should always adapt and support the technology needed in that space by its users, for instance robotics.  The bigger question might be:  if this doctor feels architects are beginning OR design from a fundamentally flawed starting point, I would be interested to hear this physician’s suggestions.

Article content like this can be dangerous information because it is a collection of non-sequiturs.  More to the point, any attempt to pull consensus ideas or derive a ‘truth’—the reader does not know what was asked of respondents and how comments were edited and selected for print—is impossible.

For me, it is helpful to read because it is educational to hear how administrators spend their air time when asked for the one thing they want or see or believe.  These are the beginnings of great discussions about progress in healthcare.

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