Five Priorities for Healthcare Design and Consulting

Lessons from a Clinician at the Intersection of Healthcare Delivery and Healthcare Design

July 13, 2017

Healthcare Consultant, NBBJ

Editor’s Note: This post was originally published as part of the Healthcare Design series “Take 5,” which asks leading healthcare design professionals, firms, and owners to tell us what’s got their attention and share some ideas on the subject.

1. Design firms should have nurse leaders on their healthcare teams.

When they augment their inherent clinical expertise with design knowledge, nurse leaders can be especially useful to architects and medical planners in validating design assumptions about healthcare delivery. Furthermore, their experience in marketing, writing, presenting, critical thinking, performance improvement, and personnel management enhances project performance and client deliverables. Consistent with the hallmarks of healthcare professionals, nurses are fundamentally caring individuals, possess palpable integrity, demonstrate respect for all, and have a quest for excellence through a commitment to personal growth and life-long learning. Honestly, what more could a healthcare design team ask for!

2. Satisfy the staff and you’ll satisfy the patients.

Design that focuses on the needs of care providers will benefit patients more than design that solely focuses on consumer amenities. This point was powerfully expressed to me recently by an acute rehabilitation hospital CEO, who relayed the feedback she got from patients involved in user groups during the design of their replacement hospital: they said, “Give the staff what they need, so that they can give us what we need.” She elaborated: “Those in need of rehab know firsthand it is the work of the therapists, researchers, doctors and nurses that get them to a state of ability and independence.” She made the point that a major component of patient satisfaction springs from satisfaction with the care experience and the care providers who create that experience. Therefore, take care of the staff’s design requirements too, and they will take care of the patients’ needs.

3. Address the full spectrum of safety.

All healthcare organizations aspire to an error-free culture of safety as part of a relentless pursuit of continuous quality improvement. Great progress has been made over the last few decades, but healthcare providers are still challenged by nosocomial infections, medication administration mistakes, work-related staff injuries, patient falls, incorrect diagnoses – the list goes on. The list of potential solutions is endless as well: strategies such as creating standard processes, mitigating distractions, establishing performance expectations, and requiring additional training and education. But one often overlooked answer is design. Some don’t even realize the range of opportunity for improvement made possible through the built environment. For instance, even the layout of a patient room can decrease errors, increase hand-washing and reduce fall rates; adjacencies can decrease travel time and supply utilization; decentralized work stations can increase patient engagement. As designers and nurse leaders, we should be more effective in communicating these benefits!

4. Technology integration can’t be an afterthought.

New healthcare designs always include a vision for advanced technology – indeed, it is often required to optimize the environment. Although this opportunity shouldn’t be passed up, it creates an extraordinary demand on the enterprise during the transition to the new setting. The information systems department is particularly pressured to have the prerequisite IT integration plan in place and functioning in time for a building’s opening. As well, there is a huge knowledge transfer requirement that affects all user departments, not to mention the department(s) responsible for educating them. Technology is a project requirement whose success or failure has a direct effect on the most important components of the client’s business: patient care and finances. It is an area that must be well thought out from the beginning.

5. Design intent is one thing – activating that design is a whole different story.

It is a thrilling time when a project is in the construction administration phase and materializing before everyone’s eyes. However, it is also the most critical and complex time, as the organization must plan to occupy and activate the new setting. It requires an extraordinary amount of effort and expertise to transition and activate the building safely and on time. Not only must new spaces and systems be fully operational, but staff must be comfortable with the space and a new way of doing business. It requires a remarkable amount of logistical coordination that cannot be underestimated or left to chance. Thankfully, many healthcare organizations seek expert assistance and advice during this time, and designers would do well to encourage them to continue to do so. Ultimately it is the design and the designer that will be assigned the blame if the activation doesn’t go well. Conversely, they will be ones to receive accolades if the activation goes smoothly and safely – with their design performing as perfectly as it was intended.

Image courtesy of Sean Airhart/NBBJ.

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The Amen(c)ity Tower

A Design Concept for the Future of Amenities in Commercial Real Estate

July 5, 2017

Editor’s Note: This post was originally published by NAIOP.

As employees increasingly work from a variety of locations and companies lease co-working spaces — or even do away with offices altogether — real estate developers and owners seek the ever-elusive “edge” that will keep their companies and their buildings competitive. To do so, developers are expanding building amenities to entice top talent and facilitate staff engagement. According to Colliers International, traditionally only 3 percent of commercial real estate was devoted to amenity space; today, the recommendation has more than tripled to 10 percent, or up to 12 percent to attract high-value tenants [PDF]. The value of increasing amenity spaces can be significant: CBRE has reported that in one instance, amenities like gyms, lounges and restaurants boosted asking rates by 15 percent.

Amenities have typically ranged from providing daily conveniences (dry cleaning, food courts, etc.) to recreation or health (gyms, saunas, clinics, etc.). To appeal to a younger generation, building owners are in a race of amenity one-upmanship, with popular amenities like table tennis and free food becoming less of a differentiator than health complexes, basketball courts and hair salons.

Drawing on Daniel Pink’s treatise on human motivation, Drive, we can postulate that most, if not all, of these amenities draw upon ideas of extrinsic motivation — what he calls Motivation 2.0. They are based on the assumption that we would rather do anything than work. They empower us to distract ourselves by taking a break, getting our hair cut, or playing some shuffleboard.

Compare that to Pink’s research that suggests organizations should instead tap into intrinsic motivation — those internal motivators for creativity and accomplishment that fill the upper levels of Maslow’s Hierarchy of Needs. Architects are beginning to understand what these ideas could mean for physical spaces and the types of amenities inside.

tower_section_fin_smAssessing these trends, NBBJ wanted to test spatial ideas of how we could address the future of amenities in urban high-rise office buildings, in an urban concept we call the Amen(c)ity Tower. Created to generate new ideas about the future of high-rises, this proposed design comprises an office tower that would be cylindrical in organization, with traditional work environments stacked at the perimeter, amenities at the building core, and social/collaborative spaces serving as the glue between the two. New amenities, now organized at the building core, are enablers of creativity. Black box performance spaces, maker spaces, holistic wellness facilities, and artist studios provide freedom to undertake the mental and physical exercise of becoming more focused, inspired and purposeful at work.

This tower scheme is based upon a premise that workplace amenities should occupy a higher proportion of leasable area — understanding that “work” doesn’t just happen at a desk. The design also requires a shift from traditional leasing strategies in which tenants lease a finite amount of space with limited access to amenities. In this model, tenants instead have access to the full range of amenities afforded by the entire vertical campus under the assumption that providing expanded access will have a positive effect on the work environment.

vertical_garden_fin_smResearch tells us that the biggest drivers of productivity in the workplace are related to interior environmental quality and focus. The Amen(c)ity Tower employs ways to optimize both.

A central vertical greenspace reaps the benefits of nature, as well as using plants to clean the air. In this case, plant species which have been proven to purify and oxygenate air such as the areca palm are distributed into columns throughout the central greenspace, enhancing both the aesthetics and functionality of the space.

Distraction dampens creativity and productivity in the workplace. According to a study by the University of California Irvine, it takes more than 23 minutes to reorient to a task after an interruption [PDF]. A Basex study has reported that workplace interruptions resulting from emails, instant messages and even casual conversations cost the United States $588 billion annually [PDF]. The Amen(c)ity Tower aims to curtail this productivity loss and mental strain through an amenity that employs an array of individual pods that completely block wireless signals, enabling greater concentration. Outfitted with acoustic dampening and full spectrum lighting, these prefabricated pods provide a comfortable space of solitude — perhaps the most undervalued amenity in today’s world.

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While workplaces have made huge gains in employee comfort and convenience, we still operate under the premise that work in and of itself is not something we choose to do. If the aim of providing amenities is to make our work better, our Amen(c)ity Tower concept seeks to understand what aspects of the workplace keep us from being our best selves, and what features might fuel our internal predisposition to be inquisitive, productive and creative.

All images © NBBJ.

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How Will The Senate’s American Health Care Act (AHCA) Bill Affect Hospitals and Health Systems?

Despite Uncertainty in Healthcare Policy, Some Strategies Remain Unchanged

June 23, 2017

Healthcare Strategist, NBBJ

@dbellef

Editor’s Note: This post has been updated to reflect the name of the Senate bill.

On June 22, Senate Republicans released their version of the American Health Care Act (AHCA), the Better Care Reconciliation Act (BCRA), a proposal to repeal and replace Obamacare. While it has differences in timing and method from the House bill, it maintains core Republican tenets of states’ rights and freedom of choice.

 

What does the Senate bill do?

Whatever final version of the Republican repeal-and-replace legislation emerges from conference, it will almost certainly:

  • Give states much greater latitude in designing their Medicaid programs and individual commercial insurance markets.
  • Put more choice and purchasing power into the customer-patient’s hands, including the option not to purchase health insurance at all.
  • Not add net new dollars into the system, even with the “puts and takes” of tax credits, subsidies and the restoration of disproportionate share hospital (DSH) payments.

And if that isn’t enough, other transitions are already underway:

  • Medicare continues to change how it pays for care, using a variety of methods: bundled payments, accountable care organizations and more.
  • Commercial insurers, in response to their customers, continue to develop a variety of different products to lower the cost to employers, which inevitably passes higher cost on to the customer-patient.

 

What doesn’t the Senate bill do?

It does not address the continuing rise in the cost to produce and deliver healthcare. Whether Republicare, Medicare or commercial care, everyone is just reshuffling how the payer pays — and hopefully reducing the amount. Obamacare was the exception: it put more money into the system but still did nothing to control the rise in cost.

But payers don’t provide care, nor can they control cost. This leaves it in the hands of care providers to figure out new ways of producing and delivering care, as all payers — from individuals, to insurers, to the Federal government — reduce the amount they are willing to pay. It cannot be overstated: no matter what Congress does, over time there will be less third-party money coming into the system, and the customer-patient will be expected to pay more and more out of pocket.

 

What now?

Because this trend will continue independent of healthcare policy, our advice hasn’t changed. Hospitals and health systems should continue to:

  • Form more partnerships with community organizations and others who have deep interests in improving community health.
  • Accelerate the development of lower-cost ambulatory and digital healthcare offerings. We are moving inexorably toward a future where healthcare is highly distributed, in the community, the home and the person.
  • Seek greater operational efficiency. Efficiency and quality go together, and we must raise the bar on both. Technologies and systems now exist in healthcare that can do this, and they should be applied to hospital and ambulatory care alike.

Regardless of whether the Senate proposal passes in its current form, in an altered form or not at all, hospitals and health systems need to accelerate their transition to becoming providers of highly reliable care that is high in quality, is error-free and provides the results it intends to provide. This is what will lower the cost of producing and delivering healthcare for us all.

 

Image courtesy of Benjamin Benschneider/NBBJ.

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